JKSES->Application Form for JKSES

      APPLICATION FORM FOR STATE SELF EMPLOYMENT SCHEME

Place for
Photograph
Text Box: Place for
Photograph
        1.     Name of the applicant (in block letters)__________________________________   
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

 

S.No

Examination Passed

Year of Passing

Division

Name of University/Board

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.
      10.      Project Cost

        a.
                   Machinery __________________
        b.
                   Buildings____________________
        c.
                   Other fixed assets_____________
        d.
                   Working Capital______________
      e.                   Total ______________________
       12.    Amount of Loan at 75% of the project cost_____________________________
       13.    Whether loan taking from any bank or financial institution so far            Yes/No.
               i.    If yes state the purpose.
              ii.    Repayment position with regard to outstanding, default, etc.
 

       UNDERTAKING BY THE APPLICANT
 

            I certify that the information furnished by me is correct and I have not so far made  any agreements for financing the
     project with any financial institution. 

                                                                            Signature of the Applicant. 

 

 
        DOCUMENT TO BE ATTACHED WITH FORM
 

        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.______________________________________________________
   Son, Daughter, Wife of _______________________________________________________________
   Resident of_______________________________________________is not an employed in Govt./Undertaking. Further
   certified that he/she is not working in any private establishment nor does he/she carry on any business in his/her name. He/she
   is not student of any institution.

                                                                                     Sig. Of the Gazetted Officer, 

                                                                                    Name _________________
                                                                                   Designation_____________
                                                           Official Seal.

 

IDENTIFICATION CERTIFICATE FROM A GAZETTED OFFICER

             I certify that Mr./Miss/Mrs._______________________Son, Daughter, Wife
     of____________________________________________Resident of _________________________________ Whose
   photograph has been attested by me and who has put his/her signature in my presence is personally known to me.

                                                                         Sig. of the Gazetted Officer. 


                Paste recent passport size                                                                      Name__________________
                Photograph duly attested                                                                       Designation______________
                By a Gazetted Officer.                                                                            Official Seal.

 


AFFIDAVIT

 

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
      am not indebted to any bank or any financial institution.

 

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
      the Govt. any other agency as authorized by the Govt. may at any time inspect/verify my/our assets.

 

                                   Deponent

Verification:-

 

            Verified that the above contents of this affidavit are true and correct to the best of my knowledge
 and belief and nothing has been concealed therein.

 

                                                                                                            Deponent
DOCUMENT TO BE ATTACHED WITH FORM

 

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).

 


  
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