| Download this form |
  |
FORMAT-I
1) Date of application
2) Control
No. :
(to
be given by NHB)
To,
The Centre In-Charge
National Horticulture
Board
...........................................................
...........................................................
(only projects upto Rs. 20.00 Lakh may
be sent to this address)
To
The Managing Director
National Horticulture Board
Plot No. 85, Sector-18, Institutional
Area, Gurgaon-122015
(Haryana)
(projects above Rs. 20.00 Lakh may be sent
to this address and a copy of the same to concerned State Office too)
Application
for Letter of Intent (LOI) under the scheme “Development of Commercial
Horticulture through production and post Harvest Management” of National
Horticulture Board)
A. grower/entrepreneur
1. Name :_________________________________
Permanent
Address :_________________________________
Postal
Address :_________________________________
2. Category
: SC/ST/OBC/Ex-Service Man
3. Gender
: Male/Female ___________ Age _______
4. Occupation:
5. Promoters/beneficiary
profile
i) Principal
Promoter/Beneficiary
ii) Others
iii)
In case of companies -
· Registration
number & date of registration
· Registering
authority
· Act
under which Registered
· Authorized
share capital _________
· Paid-up
share capital _________ Reserves & surplus _______
(by
end of last financial year)
B. PROPOSED
Activity
(Cultivation/PHM/Primary
Processing/Horticulture ancillary)
1. Name
of the Project
2. Location:
Survey/Khasra
No.___________ Village ___________, Taluka _______,
District
_________, State ___________
3. Activity
proposed under the project in details:-
(a) Area
under cultivation/project
Name of the Crops Variety (s) Area
( acres ) No. of plants Source of Planting
Material
i) .................... ..................... ...................
……………. …………….
ii) .................... ..................... ...................
……………. …………….
iii) .................... ..................... ...................
……………. …………….
iv) .................... ..................... ...................
..................... …………….
v) .................... ..................... ...................
...................... …………….
b) PHM
Activity
-
Grading & packing/Pre-cooling/Refer Van:-
c) Primary
processing
-
Activity in brief with details of products:-
d) Horticulture
ancillary industry e.g. tools, equipments,
plastics, packaging etc.
-
Activity in brief :-
e) Misc.
activities (Not covered in a to d)
-
Activity in brief :-
f) Refer
Van/Specialized Transport Vehicle
B.II (a) Whether proposed activity in
application is Yes/No
a completely a new activity
(if No, the details
of pre-existing activity
or
any component thereof included in the
application
should be indicated clearly)
.....................................................................................
.....................................................................................
(b) Whether any
subsidy has been availed Yes/No
for
the proposed proposal/activity from
Central
Govt. or any of its Agencies.
(if
YES, please indicate clearly in detail
.....................................................................................
.....................................................................................
C. Proposed project cost (Component-wise)
Component/Item
(Proposed Cost)
(a)
Cultivation (Amount in Rs.)
1) Cost
of Cultivation
(i) Cost of
planting material ..........................
(ii) Cost of
fertilizer & manure ..........................
(iii)
Source of planting material & ……………………….
proposed variety(ies)
(iii) Cost of
insecticides & pesticides ..........................
(iv) Cost
of labour ..........................
(v) Other
expenditure, if any (pl. specify) ..........................
2) Irrigation
(i) Bore-well/Tube-well
(new/old) ..........................
(iii) Cost
of pipeline (length, diameter & ..........................
type of material used)
(iv) Water
harvesting pond ..........................
(existing/new
& size)
(v) Other
expenditure, if any (pl. specify) ..........................
3) Micro
Irrigation, use of plastic mulching etc.
(i) Cost
of drip irrigation ..........................
(ii) Cost
of sprinkler ..........................
(iii)
Cost of plastic mulching ……………………....
(iv) Other
expenditure, if any (pl. specify) ..........................
4) Infrastructure
(i) Pump House
..........................
(ii) Store
..........................
(iii) Labour
quarter ..........................
(iv) Generator room
..........................
(v) Other
expenditure, if any (pl. specify) ..........................
5) Cost
of Tractor & accessories ..........................
[If
area under cultivation (project) is above 05 acres]
6) Land
development (including digging of pit & fencing..........
7) Cost
of Land, if purchased ..........................
8) Creation
of controlled atmosphere Area (sq. mtrs) Cost
a) Green house/poly house (size)
.................. .............
b) Shade net (size)
.................. .............
Total .......................................
(b) Post
Harvest Infrastructure
1. Cost
of grading/packing house ..........................
2. Cost
of grading/packing line ..........................
3. Cost
of pre-cooling unit (capacity) ..........................
4. Cost
of refrigerated van (capacity) ..........................
5.
Zero Energy Cool Chamber ……………………...
6. Other
components, if any (pl. specify) ..........................
Total ...........................
(c) Primary
Processing
1. Cost
of civil constructions ..........................
2. Cost
of plant & machinery ..........................
3. Other
components, if any (pl. specify) ..........................
Total ............................
4. Name
the product of primary processing …………………
D. proposed
means of finance
(i) Promoter’s
share ..........................
(ii) Bank/FI
term loan ..........................
(iii) Proposed
subsidy from other sources, if any ..........................
a)
Form State Govt. ..........................
b)
From Central Govt. other than NHB ..........................
Total ...........................
(Note: Unsecured
loans from friends/relatives will not be treated as equity)
Expected
back-ended subsidy from NHB: Rs. …………………
(NHB subsidy will be
considered as per Board’s guidelines, if found in order, but not guaranteed)
(e) Expected return/income from the proposed
project.
a) In case the project cost is above
Rs. 10.00 lakh, a brief project report containing technical feasibility and
financial viability should be enclosed alongwith application
..............................................
b) In case of project cost is up to
Rs. 10.00 lakh, the information pertaining to cash flow from the proposed
project may be given as under : -
(Amt.
in Rs.)
Year
Expected Expected Expected Total Estimated
Gross Expenditure Working expenditure
Net
Income on fixed/ operating (3+4)
Income
capital assests expenditure (2-5)
(excluding)
repayment of
loan+interest)
1
2 3 4 5
6
1st year
2nd year
3rd year
4th year
5th year
...........
...........
E. Existing
status of project
(Please give details
about the activities of the proposed project already completed at the time of
submission of application of Letter of Intent (LOI)
...............................................................................................
...............................................................................................
...............................................................................................
G. Whether
any assistance in the form of soft loan and subsidy has been availed by the
beneficiary earlier from the National Horticulture Board? If yes, give details
thereof.
...............................................................................................
...............................................................................................
H. Whether any subsidy has been availed
from the Board, other Central Govt. organization or State Govt. for the same
activity on same piece of land, khasra no. etc.?
...............................................................................................
...............................................................................................
Details of subsidy, if availed from:
(i) MFPI :
(ii) AYUSH
(Ministry of Health & Family Welfare) :
(iii) APEDA
:
(iv) NHM :
(v) Technology
Mission :
(vi) National
Bee Board (NBB) :
I. Name of the Bank/FI from where the term
loan is availed/to be availed by the Beneficiary (Please enclose a copy of the
duly filled up term loan Application).
a) Name of Bank:
......................................................................................
b) Details of Bank Branch:
……………………………………………….…………………
c) Bank
Code:………………………………………………………………….………………..
J. Date & Amount of sanction of term
loan, if any : ______________________
K. Details of release of term loan, if any: ______________________
L. Details
of land
i) Whether
own land (ancestral) : _________________________
ii) Whether own land purchased : _________________________
iii) Whether leased
If so, how many years lease : _________________________
iv) Whether lease/tenancy/contract is
registered with the Competent Registration Authority
(copy of the proof of each title be
enclosed)
M. Implementation
schedule of proposed activity
i) Proposed
month for undertaking land development:
ii) Proposed
month for plantation:
iii) Expected
date/month of first commercial crop:
iv) Proposed
date for start of unit in case of processing:
N. Marketing of produce
Details of marketing
tie-up (Backward/forward linkage)
O. Cost
of Application Form & Scheme Brochure will be as under:
Projects costing upto Rs. 10.00 lakh :
Rs. 1000/-
Projects costing above Rs. 10.00 lakh
and below Rs. 20.00 lakh :
Rs. 2000/-
Projects costing above Rs. 20.00 lakh
and below Rs. 50.00 lakh :
Rs. 5000/-
Projects costing above 50.00 lakh :
Rs. 10000/-
The
above prescribed cost of application form and brochure will be non- refundable.
P. Please remit the
cost of application and scheme brochure by Demand Draft drawn in favour of
National Horticulture Board payable at Gurgaon (Haryana) for projects costing
Rs. 20.00 lakh & above and at concerned state office where project cost is
below Rs. 20.00 lakh.
Name
of the issuing Demand Draft No. Amount(Rs.)
Bank
Branch & Date
................................
............................... ..............
Q. Name &
address of consultant who prepared the project report (DPR).
Certified
that the information/contents as above furnished by me/us in the application
are true to the best of my/our knowledge & belief and nothing material has
been concealed. In case, any information furnished in the application is found
false, my/our application may be rejected out rightly at any stage by the
Board.
(Signature of the Beneficiary)
Name & Address : .........................
Place:
Telephone/Fax No. .........................
Date
:
Enclosures:
i) Attach copy of
record of right over project land.
ii) Affidavit
in prescribed format only.
iii)
Prescribed cost of application form and scheme brochure.
iv)
Detailed Project Report (DPR) - wherever applicable
iv) Duly
filled up and signed bank term loan application form/bank consent letter
v) Copy
of last Income Tax Return, if any.
vi)
Key map of project land showing project details and land boundary details.
vii)
NOC issued by Cooperative Society/Partnership Firm, if applicant is covered
by Para- 5(h) of Guidelines No.1/2008.
viii)
Proof of identity of applicant (refer Para of 3 Guidelines No. 1/2008.)
ix)
In case project include item of 'Primary Processing' for manufacturing 'Fruit
Products" covered by FPO 1955 then NOC issued by MFPI, Govt. of India be
enclosed.
FORMAT-II
Affidavit
(on stamp paper of Rs. 20)
I/we ............................................
(Name of the promoter/Director son of Mr……..........................(father’s
name) resident of ........................................ (residence address)
do hereby solemnly affirm and declare as under:
1. That
I/we am/are individual grower/promoter/director/partner/group of
growers/association of growers/proprietor of M/s ..........................
.................................. (name of beneficiary) having its
Registration no. …………………….. Registered Office at
........................................ (office address of beneficiary).
2. I
hereby make application and I am duly authorized in my own right/by management
vide its resolution no. ……………..dated …………..to apply and sign all required
documents including this affidavit on behalf of company/partnership
firm/cooperative society named as ………………… ; and am fully aware of the facts
relating to the setting up the project at Survey No. .....................,
Village…………….., Tehsil…………., District…………..State…………….. (location of the
project) for .............................. (activities to be undertaken by
project) and application is being made to NHB for seeking Letter of Intent
(LOI) under the scheme “Development of Commercial Horticulture through
Production and Post Harvest Management”.
3. That
the term and conditions of the scheme of NHB under which an application is made
by the applicant have been properly read and understood by me and I affirm that
the project/proposal/scheme comply with the terms and conditions of NHB and the
application is made in the correct applicable scheme.
4. That
the proposed activities to be undertaken by the project/proposal scheme are
covered under the above scheme of NHB and no part of the scheme/infrastructure
of the project is designed or assigned to be used for any activity other than
the horticulture activities specified in the application at present or in the
near future.
5. That
the information provided in the application of Letter of Intent (LOI) is true
and correct to the best of my knowledge and belief. The estimate of the cost of
project/proposal/Scheme, financial viability and operating results have been
worked out/computed as per the rule and generally accepted principle and norms
in this regard.
6. No
subsidy/grant-in-aid other than shown in application form has been availed/is
to be availed by the promoters/ directors/partners/proprietors for this new
project and component thereof from Central Govt. or any of its agencies Except
the NHB.
7. Myself
or any other promoter of Cooperative Society, Partnership Firm, Self Help Group
has not availed any subsidy from NHB which has not been disclosed in the
application.
8. I/we
also solemnly affirm that the proposal activity in the application for LOI is a
completely new activity and not a pre-existing activity or any component
thereof.
9. That I have thoroughly examined notification F. No. 45-64/2010-Hort dated 25.02.2010 for prescribed technical standards w.e.f. 01.04.2010.
10. That I accept and undertake that the Technical Scrutiny of the documents by NHB or its empanelled agencies shall not in any way obviate the responsibility of the Promoter/deponent, to scrutinize his project and insure that it invariability complies to the prescribed technical standards w.e.f. 01.04.2010 vide notification F. No. 45-64/2010-Hort dated 25.02.2010".
11. That in case of concealment of any facts in this regard, the Board would have right to reject my application out rightly at any stage. .
DEPONENT
VERIFICATION
Verified on solemn affirmation at
..................................... (place) on this ............ (date) of,
.................... (month), 20 .................(year) that the content of
the above affidavit are true to the best of my knowledge and belief and nothing
material has been concealed.
Depondent
(Self Certification Format to be obtained on a stamp paper of Rs.100)
DECLARATION
I/we ............................................
(Name of the Consultant)Age............son of Mr.(father’s
name) resident of ........................................ (residence address)
certify that :
1. That I am a graduate engineer and have adequate experience / expertise in designing, Constructing and commissioning cold stores, insulation & cooling system and cold chain infrastructure equipment.
2. That a copy of my graduation / post graduation certificate of B.E. / B. Tech / M. Tech is enclosed and shall form part of my certification and declaration.
3. That I am the project / Technical Consultant and have been hired by the project promoter________________________ to design, conceptualize and prepare the project DPR bearing Ref. No.____________________.
4. That I am fully conversant with relevant codes and standards applicable to the cold chain infrastructure and affirm invariable compliance of the project to the above mentioned prescribed Technical Standards.
5. That I have thoroughly examined notification F. No. 45-64/2010-Hort dated 25.02.2010 for prescribed technical standards w.e.f. 01.04.2010.
6. That I certify that the components of insulation and refrigeration systems in the prescribed format of the technical data sheet conform the ratings and performance of selected equipments and proposed design as per the prescribed Technical Standards w.e.f. 01/04/2010 vide notifications F. No. 45-64/2010-Hort dated 25.02.2010.
7. That I undertake to adhere to the requirements of confidentiality and non-compete with respect to proprietary information entrusted to me by the promoter/manufacturer of equipment / the Board.
8. That I will assist the Government inspection and regulatory agency during stage inspection of the project and provide any/or all technical clarifications as and when required.
9. That I will furnish a certificate of satisfactory commissioning of the cooling system in conformance to the performance indicators as per the prescribed standards.
10. That in case of any concealment of facts by me in the DPR with respect to invariable compliance to Technical Standards or on any instance of false declaration / certification by me or any part of my declaration is found to be incorrect, the Board may, in its discretion, take any actions (including legal action) against me as deemed fit and proper.
IN WITNESS WHEREOF,
the consultant has signed this declaration and certification on this ____ day of ____ 2010 in the presence of the following witnesses;
WITNESSES:
(1.)
……………………....
(2.)
……………………....
(Signature of the Consultant)
|
