Imp drishti farm to fork club
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1. The document is a 6-page registration form for the Drishti Farm to Fork Club (DFTFC). It collects personal and farm details from prospective members to assess their eligibility for the club's services and credit facilities. 2. The form requests information on the member's identity, family, landholding, crops, livestock, assets, income, expenses, loans and other financial details. It also outlines the club's terms, fees, and benefits including advisory services, input supplies, marketing support and eligibility for credit up to Rs. 5000 per acre. 3. Members must have a minimum landholding of 5 acres and pay form fees, annual membership fees, and a refundable security deposit based on
Imp drishti farm to fork club
- 1. DRISHTI FARM TO FORK CLUB (DFTFC) Page 1 of 6 Registration Form FRN Number : ______ ______ __________ Name of Member :______ _______ __________ Contact Person :______ ________ __________ Present Address : ________ _________ ________ Farm Address :________ __________ ________ Mobile No : _____________ Email :_________ _____________ Caste : GENETAL/ RESERVED Category : Small / Marginal / Corporate/ Landless Farmer Socio-Economic Status of Member : _______ ________ _________ KYC DETAILS Sr.No. Particulars ID Card Number Issue Date Expiry Date Issuing Authority 1 PAN Card 2 Election Card 3 Driving License 4 Aadhar Card 5 Pension Card 6 Passport FAMILY DETAILS Sr. No. Name & Relationship PAN No. Date of Birth Education Experience Land Holding In Acres Income & Its Source Contact No. Details of Technologies Adopted for Farming : Micro-Irrigation : Protected Cultivation : Farm Mechanisation : Details of Subsidies / Government Schemes Benefits availed till date : Request for Services of SCSG : 1. Techno-commercial Advisory of Agri – Projects 2. Technical advisory for Crop Production & Pest Management 3. Technical Advisory on Post Harvest Management 4. Marketing Support for Agri Produce 5. Support in availing Agri Inputs for Farming and Medicines for Animal Husbandry 6. Support & Advisory on Availing agri-finance from banks 7. Advisory on Financial Management for better Farm Operations 8. Advisory on Government Schemes for Agriculture and Rural India Affix Latest Photographs
- 2. DRISHTI FARM TO FORK CLUB (DFTFC) Page 2 of 6 FARM DETAILS Sr. No. Survey/ Block No. Moje & Taluka Type of Holding Area Hectare Type of Land Type of Irrigation Charge on land, if any Free hold Lease Hold Jt Ownership Irrigated Pasture Plantation Cultivable Surface Tubewell / Canal / Dug Well / Drip / Sprinkler (submit copies of documents of land holdings) Animal Husbandry Details: Cow : _____ , Buffalo : ______ , Other____: ________ Average Milk Per day :________ Litres, Price/ Lt ____ Rs. = Income PA :__________ Rs. ( 270 days of 80% Cattle) Cost of Production Of Milk : Labour Per day : ____ Man Hours, Medicines & Nutrition :______ Rs. / Month, Feed / day ____ Kgs @ Rs.___/ Kg Present Income Details : Income from Farm Operations : ______________________________________ Income from Animal Husbandry : ______________________________________ Income from Other Sources (_______) : ______________________________________ BANK DETAILS Sr. No. Name of the Bank Branch Name Type Of Account & IFSC Code Account No. Average Balance & Banking Conduct CROP DETAILS Crop Date of Sowing Cost of Production. Total Cost of Cultiv ation Total Yield Gross Income Other Costs Like - Insurance , Finance, Comission etc… Remark Labour & Land Preparat ion Planting Materials, Nutrition & Pest Mgt Harvesti ng, Post Harvesti ng & Mktg (submit copies of documents for Income & Expenses )
- 3. DRISHTI FARM TO FORK CLUB (DFTFC) Page 3 of 6 ASSET DETAILS A. IMMOVABLE ASSETS Sr. No. Nature of property Location Freehold / Leased / Jointly owned Cost (at the time of purchase) Present estimated market value of the property/ies Whether encumbered /unencumbered/ partially encumbered. Give details. (with whom, consideration and major T&C) 1 House / Building 2 Tractor Shed / Farm Shed 3 Fish Pond/Tank 4 5 6 B. MOVABLE ASSETS Sr. No. Nature of property Number Cost of Purchase Present Market Value 1 Ploughing animal 2 Milch animals 3 Farm birds 4 Diesel Motor Pump 5 Electric Motor Pump 6 Transport Vehicle 7 Tractor 8 Other implements 9 10 C. LIC POLICIES Sr. No. Particulars Policy-1 Policy-2 Policy-3 Policy-4 Policy-5 1 Policy No. 2 Date of issuance of policy 3 Sum Assured (Rs.) 4 Branch Name 5 Annual Premium (In Rs) 6 Premium paid to what period 7 Name of the Co. 8 Total No. of Shares held 9 Certi. No. A/C No. 10 Total Amt Rs. (Face value) 11 Whether fully paid? (YES/NO) 12 Current Market Value Rs. D. TERM DEPOSITS Sr. No. Particulars 1 2 3 4 5 1 FDR/RDYSJY A/C No. 2 Date 3 FVG. 4 Amt. Rs. 5 Name of Bank/ Branch 6 Due Date 7 Maturity Value Rs. E. INVESTMENT IN GOVT SECURITY LIKE BONDS/NSE etc. Sr. No. Particulars 1 2 3 4 5 1 Bond/ Certi. No. 2 Date of Purchase 3 Issuing Office/ Post office Add. (including mutual Fund) 4 Amt. Rs. 5 Due Date 6 Maturity Value Rs.
- 4. DRISHTI FARM TO FORK CLUB (DFTFC) Page 4 of 6 LOAN/LIABILITY DETAILS A. Details of Borrowing Sr. No. Name of lending institution/ Bank Purpose of Loan Present Out Standing Amount of instalment due during the year Overdue Amt of Installment (If Any) Collateral Security Offered B. Liabilities as a Guarantor Sr. No. Guarantee given on behalf of Name of Bank/Institution in whose favour guarantee is given Amount of guarantee Present outstanding/ liability Status of A/c (Regular/ Overdue) Type of Loan Requested : ____________________ _______________________________________ Amount of Loan Requested : Rs.___________________________ Purpose of Loan : _________________________________________ Expected Repayment Schedule : _____________________________ DETAILS OF SECURITY TO BE OFFERED Sr. No. Details of Property Estimated Market Title StatusMarket Value Realisable Value Distress Value A. Primary i ii iii B. Collateral (wherever applicable) i ii iii DETAILS OF GUARANTORS (IF ANY) Sr. No. Name of The Guarantor Address Net worth DECLARATION I / we hereby declare that the information given above is true and correct to the best of my/our knowledge and belief. I/we hereby authorize the Shiva CSG Pvt Ltd to disclose all/any of the details/information available with the Company relating to my membership accounts in case of need or as desired by the company to any other financial institution, government or any other agency/agencies. If any information given by me/us is found to be incorrect, the Company will have the right to disqualify me/us for availing any membership benefit & Credit facility. I/we hereby declare that as on the date of the application, there is no other loan/liability outstanding in my/our name other than those mentioned above. I/we hereby undertake that on sanction of the loan we shall abide by the terms and conditions laid down by the Financial Institution and will inform the respective agencies about the acquisition of other assets during currency of the loan. Place: (Signature/Thumb Impression of Borrower/s)Date:
- 5. DRISHTI FARM TO FORK CLUB (DFTFC) Page 5 of 6 Salient Features of DFTF Club Membership : 1. Timely advisory on Crop Production, Crop Protection and Crop Nutrients by Experts of Shiva Consultancy Group 2. Regular & Continuous Field visit for Farm Operations of Agriculture, Horticulture, Farming, Dairy and Integrated Farm Operations by Shubham Agribusiness Services. 3. Regular Advisory on Banking, Finance, Investment and Government Schemes related to Farming and Rural Development by professional team of Shiva CSG Pvt Ltd.. 4. Education and Training for Employment Generation activities within the rural area by Shiva CSG Pvt Ltd. 5. Uninterrupted Supply of Relevant Farm Inputs directly to farm for smooth operations through dedicated Agripreneurs chain of Drishti Biotech Pvt Ltd in your area & through Portal D2F on Discounted Rates. 6. Support and advisory on Value addition in Farm Produce and Marketing through dedicated network of D2F Portal and Shiva Consultancy Group Terms & Conditions Of DFTF Club Membership : 1. Any Farmer with minimum 5 Acres of Land can become member of DFTF Club by paying ( following 3 types of fees) a. Form Fee @ Rs. 100 per acres of Land Holding ( One time Form Fee) , b. Membership & Service Fee @ Rs. 1000 per Acres/ Annum & c. Refundable Security Deposit @ Rs. 2000 per Acres . 2. Any member of DFTF Club is entitled to avail a. Credit facility of Rs. 5000 per acres for Agri Input Supply by Drishti Biotech Pvt Ltd and b. Free Advisory on Farm Management and Commodity Marketing by Professional Team of Shiva CSG Pvt Ltd. 3. Any member can avail assistance of Financial Advisory Services for the year by giving request along with only 10% of Fees decided mutually and rest after completion of the project. 4. Duly filled in DFTFC form along with following documents need to submit to Shiva Consultancy Group to allot Membership Number and detailed scope of services a. Copy of all relevant KYC documents, b. Copy of Land related documents and c. Copy of banking related documents. Declaration : I/ we _______________________________________________________ understand all the terms and conditions of the membership and thus paying the form Fees of Rs.____________ towards my total land of _____ Acres as per details filled in application form. Further paying Rs. _______________ by Cash/ Cheque/ DD No_____________ Dated ___________ from________________________________ towards Annual Membership & Service Fee and Security Deposit in favour of Drishti Biotech Pvt Ltd. I / we declare that all the information provided in the form are true. I/we will abide all the instructions provided by Shiva Consultancy Group for betterment of my Farm Productivity, profitability and Socio-cultural betterment. I / we promise to pay timely / on demand all the bills and Invoices raised by Shiva Consultancy Group and any Business associates in Good faith towards Products and Services supplied by them to keep smooth business and transparent operations. Place: (Signature/Thumb Impression of Borrower/s)Date: For Office Use Only : Allow / Disallow Assign Membership Number :
- 6. DRISHTI FARM TO FORK CLUB (DFTFC) Page 6 of 6 Signature