APPLICATION FORM FOR STATE SELF EMPLOYMENT SCHEME
![]() 2. Sex (Male/Female)________________________________________________ 3. Particulars of Father/Husband i. Name_______________________________________________ j. Permanent address (Where residing for the last more than three years __________________________________________________________________ 4. Particulars of applicant a) Permanent Address____________________________________________________ b) Village/Mohalla________________________________________________________ c) Post Office_____________________________________________________________ d) Block__________________________________________________________________ e) District________________________________________________________________ f) Address for corresponding_____________________________________________ g) Date of Birth_________________________________________________________ h) Academic and technical qualification
i) Experience in the trade selected for self-employment. j) Specific training received (give details of training, duration, name of institution) k) What have you been doing after passing the last examination. a) Service ________Govt./Govt. Undertaking Yes/No. b) Business/ Agriculture Yes/No. c) Self-employment Yes/No. d) Service in Private Establishment Yes/No. l) Present employment status Employed/Unemployed. m) Whether registered with Employment Exchange. n) Whether a member of Scheduled Cast/Scheduled Tribe/OBC(please specify) 5. Type of Activity proposed to be undertake_______________________________ 6. Previous experience_________________________________________________ 7. Place where the activity is to be undertaken.______________________________ 8. Whether Premises available Yes/No. i) If Yes, State the specific arrangement made as under:- a) Rented: b) Owned:
9. Whether construction of premises is a
part of the project Yes/No.
I certify that
the information furnished by me is correct and I have not so far made
any agreements for financing the Signature of the Applicant.
Photostat attested copy of: i. Date of Birth Certificate ii. Qualification Certificate iii. State Subject iv. 1st Page of Ration Card v. Identification Certificate as prescribed by the Deptt.(Original) vi. Un-employment Certificate from a Gazetted Office
vii.
Affidavit as prescribed by the Deptt.(Original).
CERTIFICATE ABOUT UNEMPLOYMENT OF THE CANDIDATE TO BE ISSUED BY A GAZETTED OFFICER.
Certified that Miss/Mrs./
Mr.______________________________________________________ Sig. Of the Gazetted Officer,
Name _________________
IDENTIFICATION CERTIFICATE FROM A GAZETTED OFFICER
I certify that Mr./Miss/Mrs._______________________Son, Daughter, Wife
I, _____________________________________________S/o, D/o, W/o ________________________________________________________ R/o. _________________________ do hereby declare on oath as under: 1. That I am an Unemployed.
2. That I will muster 5% of the cost of the project plus the amount of the total shortfall after deduction of the amount of subsidy.
3.
That I have not drawn any loan/assistance under
any scheme either of the State or Central Govt. and I
4. That I am permanent resident of J&K State.
5. That I shall abide by all the rules framed under the J&K S.S.E.S. for Educated Unemployed Youth.
6. That I shall submit progress report to the concerned authorities if required.
7.
That the Govt. representative from the bank,
representative of RBI or any other agency as authorized by
Deponent Verification:-
Verified that
the above contents of this affidavit are true and correct to the best of my
knowledge
Deponent
Photostat attested copy of:- a. Date of Birth Certificate b. Qualification Certificate c. State Subject d. 1st Page of Ration Card e. Identification Certificate as prescribed by the Deptt. (Original) f. Un-employment Certificate from a Gazetted Officer g. Affidavit as prescribed by the Deptt.(Original). |
|||||||||||||||||||||||||||
|