APPLICATION FORM
Cooperatives under FSC Scheme
Regional Office, 5th
Floor, Co-Bank Towers , Palayam,
Trivandrum
Phone: (0471) 2318497 Fax: (0471)
2311673,Web site
: www.ncdc.in
Email - RO.TVM@ncdc.in
NCDC SPONSORED
SCHEME FOR PROVIDING FINANCIAL ASSISTANCE
TO FARMERS SERVICE
COOPERATIVES ( FSC ) – APPLICATION OF THE
SOCIETY FOR ASSISTANCE
1. Name and complete address of the Society :
alongwith Phone No.
2. Type of Society :
3. Management of the Society:
a)
Board of Directors
:
Elected/Nominated
b)
Whether the Society has full time
Manager/Secretary :
Yes/No
c)
Membership & share capital (details) :
4. Godown capacity available with the society :
No…………. Cap. (in tons)
a)
Owned :
b)
Hired :
5. Whether Society has availed
assistance : Activities
Year Amount
Earlier from NCDC, if so please
indicate under of assi-
Which stance
assistance
availed
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6. Financial status of the society
please specify year
a)
Profit (+) Loss (-) for last 3 years : Year Profit/Loss
-------------------------------
-------------------------------
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b)
Accumulated profit/loss : Year
Profit/Loss
c)
Total own funds
(comprising paid up : i) Paid-up
share capital
share
capital, reserve funds and
ii) Reserves
undistributed
profit) as on ……………. iii) UDP/Acc. Loss
---------------
Total
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-1-
7. Inputs distribution and other business :
Achievement Targets
Performance for last 2 years and Year Year
Targets of the society for next
2 years. (value in Rs. In lakhs)
(2009-10) (2010-11) (2011-12)
(2012-13)
a)
Fertilisers :
b)
Seeds (Rs. In lakhs)
:
c)
Pesticides (Rs. In lakhs)
:
d)
Other inputs (Rs. In lakhs)
:
e)
Consumer business (Rs. In lakhs) :
f)
Other business (Pl. specify)
:
--------------------------------------
Total :
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8. Working capital and margin money
requirements for inputs and other
business.
:
a) Expected peak level stock : Commodity Value Commodity Value
for current year & next year
a)
b)
c)
d)
e)
f)
b)
Commodity wise margin of
: Commodity Margin of Security
security to be provided to the
Bank for raising working capital
(indicate in percentage)
a)
b)
c)
d)
e)
f)
- 2 -
c)
Amount of margin money : Current year Next
year
Commodity Margin Commodity Margin
Money Money
a)
b)
c)
d)
e)
f)
------------------------------------------
Total
-----------------------------------------
d)
Own funds
available for business :
-------------------
Total
------------------
e)
Net margin money requirement
: Current year Next year
(c-d)
Signature
Manager of the Society
Certified that the proforma has
been scrutinized and is found to be complete in all respect.
Assistant/Dy. District Registrar of Cooperative Societies
(In-charge of District)
NB : 1. Please
strike out whichever is not applicable in the above
proforma.
2.
Enclose financial statements audited / tentative for last 3 years
comprising of P&L ,Trading & Balance sheet and item wise
details
of non-credit business undertaken qty
and value wise
for
last 3 years.
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