1. Title of the scheme / project:

   1. Name and address of the Institute/ Scientist

   2. Name and address of the Head of
      the Institute

   3. Actual Location where the work
      will be conducted

2. Location:

3. Information regarding Principal Investigator / Scientist:

   1. Name and Designation 

   2. List of other projects carried out / being carried out by the Principal Investigator / Scientist
      with financial support from various organizations (including CDB) 

   3. Brief Bio-data of the Principal Investigator/Scientist indicating his specialization interest, particularly in relation to the proposed research work.. 

4. Information regarding other Scientists to be associated with the Investigation:

5. Objectives of the project:

6. Practical / Scientific Utility:

7. Review of research conducted on the subject in India and abroad

8. Technical programme

9. Facilities available

10. Duration of the project

11. Staff requirements

12. Estimates of cost 

    1. Recurring 

    2. Non-Recurring

    3. Institutional Charges 

     

Undertaking

1. The Research work proposed in the scheme does not in any way duplicate the research work already done and being carried out elsewhere on the subject.

2. The scale of pay, allowances, etc. proposed above are those admissible to the persons of corresponding status employed under the research institute.

3. The present scheme can not be combined with any other scheme financed by the ICAR / CSIR, Central and State Government, Universities or Private Institutions.

4. Necessary provisions for the scheme will be made in the Institute in anticipation of the sanction to the scheme by the Coconut Development Board.

5. We undertake to abide by the guidelines provided by the Coconut Development Board for the implementation of the adhoc projects. 

Signature 
(Principal Investigator / Scientist –in-charge of the project)

Name:

Designation:

 
Signature
(Head of the Institution) 

Name:

Designation:

1. Name of the applicant :
   (In block letters initials after name)

2. Address of the applicant : 
   (In block letters) 
   
                                       Pin ..................... 

3. Whether belongs to SC/ST / General : 

4. a) Total area possessed by the cultivator:.................... ha. 
   
   b) Total area under coconut : .....................ha.

5. Details of demonstration plot:

   Sl. No.	Survey No.	Area (in ha.)	Village	Taluk	State

   ** Necessary documents to prove the ownership of the land, such as a copy (attested by a Gazetted Officer) of the land tax receipt (of applying year), or possession certificate should be submitted along with the application.

6. Whether the applicant is the owner of the coconut garden : Yes / No

7. Type of soil : Sandy / Loamy / Alluvial / Laterite / clayey

8. Mode of irrigation: Basin / Sprinkler / Drip / Canal /Pot

9. Details of the coconut palms in the demonstration plot.

   Variety (cultivars)	Nos.	Age	Average yield of the palm before / after adoption of scientific practices	Cost (Rs) per year
   i) Hybrid
   ii) Tall
   iii) Any other  variety

10. Insect pest and disease management:
    
    a. Name of the pest / disease
    
    b. No. of pest / disease affected palms
    
    c. Technology adopted for management

11. Details of management practices adopted in the demonstration
    plot & expenditure incurred.

    Sl. No.	Item	Qty./ Palm	Amount(Rs.)
    (i)	Application of organic manure
    (ii)	Application of fertilizer
    (iii)	Plant protection measures
    (iv)	Irrigation expenses
    (v)	Land development works
    (vi)	Inter-cultivation / weed control
    (vii)	Removal of disease affected palms
    (viii)	Replanting expenditure
    (ix)	Intercropping / Multi cropping
    	Name of crop a) . . . . . . . . . . . . . . . . . . . . . . . b) . . . . . . . . . . . . . . . . . . . . . . . c) . . . . . . . . . . . . . . . . . . . . . . . d) . . . . . . . . . . . . . . . . . . . . . . . e) Mixed farming or any other related works.
    	TOTAL:

Declaration of applicant 

I . . . . . . . . . . . . . . . . . . . . . . . . . . .  (S/o/W/o/D/o) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . hereby declare that the information furnished above is true and correct and I shall abide by the terms and conditions prescribed by the Coconut Development Board for availing of the financial assistance to maintain the demonstration plot from time to time. I have incurred / shall incur Rs. . . . . . . . . . . . . . . . (Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . only) towards the expenditure for adopting scientific management practices in my coconut garden with . . . . . . . . . . . . nos of palms covering an area of . . . . . . . . . . . ha. during the year . . . . . . .

(Signature of applicant) 

Place:
Date: 

Certificate

(Certificate of Agricultural Officer of the State / 
Technical Officer of the Board / ICAR)

I, Shri./Smt. . . . . . . . . . . . . . . . . . . . . . . . . have inspected the demonstration plot and to the best of my knowledge and belief the applicant has done the management practices in his / her coconut garden as per his statement in this application form. I certify that the applicant has incurred an amount of Rs . . . . . . . . . . . . (Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . only) for adopting scientific management practices in his / her coconut garden maintained as demonstration plot covering an area of . . . . . . . . . . . . ha. with . . . . . . . . . . . . nos of coconut palms.




Place: (Signature) 
Date: (Office Seal) Name and Designation of the Officer 

For Office use only

Verifying Officer’s Remarks:

(Signature)

Name and Designation

Order of Sanctioning Authority



Sanctioned Rs. . . . . . . . . . .. . . (Rupees . . . . . . . . . . . . . . . . . . .) 

(Signature)

Name and Designation 

Instructions for filling application

Application without signature of the officer concerned and office seal in the certificate will be summarily rejected. The applicant should sign in the declaration form.

1. Name of the Unit :

2. Date of establishment with Reg. No. :

3. Address : 

a. State :

b. District : 

c. Tahsil / Taluk :

d. Panchayat / Municipality : 

e. Town / Village :

f. PIN Code :

g. Street & Bldg. No. :

h. Phone / Fax / Telex :

i. E- Mail :

 

4. Nature of Organisation : Proprietorship / Partnership/ Joint Stock Company

5. Details of documents attached :
(Attested copy of deed/Articles of Association)

6. Location of the unit

a. Revenue Village

b. Survey No. with area of the plot 

c. Ward and Door No.

d. Boundaries of the unit

North 

East

South

West

 

7. Address of the registered office of the unit, if any

8. Total Investment of the project :                  Rs.

a) Investment on land and building :       Rs.

b) Investment on plant and machinery :  Rs.

c) Working capital :                              Rs.

9. Name(s) of the product(s)

10. Details of process technology

11. Source of know - how

12. Date of commissioning of the unit

13. Installed capacity of the unit

a) Annual production target

b) Annual production achieved 

c) Capacity utilization

14. Power consumption (in HP / kw)

15. No. of employees in the unit

16. Selling price of the product

17. Sales turnover (Year)

18. Annual profit / Loss after taxation

19. Name & address of the main buyers of the product(s)

I/ We hereby declare that the information furnished above is true to the best of my/our knowledge and belief. I/we fully understand that if any of the information furnished is found incorrect or false the subsidy granted to the unit is liable for cancellation in addition to any other penalty that the Board may impose depending on the merit of the case. 



Name and addresses of the / Partners/ Directors





(Signature of applicant)



Place:                                                             Name:

Date:                                                              Address:

Certificate

Name of the Chartered Accountant(s)

.................................................................................

.................................................................................

We hereby certify that M/s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . have acquired the following fixed assets after formation of the industrial 
unit at . . . . . . . . . . . . . . . . . . . . . . . . in . . . . . . . . . . . . . . . . . . . . . . . for the manufacture of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

We have checked all the ledgers, account books, balance sheet, stock registers etc. and certify that the aforesaid information has been verified and found to be true. We also certify that all the aforesaid purchased items have been entered in the stock register.



Place:                                          CHARTERED ACCOUNTANT(S)

Date:

Documents to be attached with the application:

1. Project cum feasibility report.

2. A copy of registration certificate of the unit.

3. A copy of letter of credit and solvency certificate.

4. Registered partnership deed / memorandum of articles of association.

5. Bio-data of the proprietor/partners/directors and their permanent address.

6. A copy of agreement, if any, entered into for transfer of know-how.

7. Copies of annual report.

8. Certificates from Chartered Accountant regarding the value of assets.

9. Technical and managerial background of the promoters in running the business.

10. Site plan of the plant and building.

General Conditions

1. A sign - board/ label indicating that the unit is purchased/constructed with the financial assistance of the Coconut Development Board. 

2. The unit is purchased/constructed under the scheme should be utilised for bonafide purpose and should not be sold or transferred to any person without the written sanction of the Coconut Development Board.

3. The beneficiary shall not hinder the Officers of the Board duly authorised by the Chairman in inspecting his premises at any time.

4. Original bills/ cash receipt in support of purchase of unit have to be enclosed with the application. If any Bank loan is availed certified copy of bill / receipt from the Bank Manager is to be enclosed.

5. Grant-in-aid will be released by way of crossed Demand Draft / Banker’s draft.