1

ANNEXURE-I

APPLICATION FORM FOR AGRICULTURAL MACHINERIES AND IMPLEMENTS

To

The Executive Engineer (Agri) / Asstt. Executive Engineer (Agri) ..................................................

Name of the Scheme .........................................................

Name of Machine Applied For...........................................

No. of KCC/ PMJDYor SB Account .............................. Name of Bank..............................

Branch...................

1. Name of the Farmer/ Secretary of Group (ASG) /PPS/JLG:

2. Father’s/ Husband’s name :

(in case of individual farmer)

3. Address of Proposed Project Location :

Village : Post Office & PIN code :

Police Station : ADO Circle :-

Block : District :

L.A.C. : G.P:

4. Detail of members of the ASG/ PPS/JLG –

Sl.

No.

Name of the Member Father’s/ Husband’s

name

Educational

Qualification

Category of

farmer

(ST/SC/Gen)

Gender

(Male/

Female)

Area of

cultivable

land under

possession

(in Bigha)

KCC/

PMJDY or

SB a/c No.

1 2 3 4 5 6 7 8

1

2

3

4

5

6

( Enclosed Land holding certificate/revenue receipt/cast certificate of each member as applicable from competent authority).

5. Name of the ASG/PPS/JLG :

6. Regd. No. of the PPS :

7. Category of farmer under the PPS/ ASG (in nos.)

Category Male Female Land Holding ( Bigha)

Landless

Small

Marginal

Large

Total

8. Land situation : High/ Medium/Low/Flood affected

Group

photograph

of ASG/

JLG/ PPS

2

9. Present land use pattern :

Sl. Cropping season Crops grown Area

(in Bigha)

Cropping

Intensity

1 Summer

2 Winter

3 Autumn

10. Availability of irrigation facility within the PPS area –

Sl. Source Area (in Bigha) Name of scheme & year

1 STW

2 LLP

3 FIS

4 Other means

11. Choice of Brand & Model :

Brand Model Hp Implements

(For Tractor)

(from the approved list of the Department of Agriculture)

The information given above are true and certified that I/we have not availed any earlier assistance from

the Govt. for the machines applied for

Full signatures of the applicants & contract No.:

Sl. Full signatures of the applicants Contact No.

1

2

3

4

5

6

Signature of Secretary of PPS Signature of Secretary of ASG

(Seal) (Seal)

1. Xerox copy of Voter ID of applicant(s) and KCC/ PMJDY or SB a/c book

2. Certified that the ASG/JLG/PPS has not availed any assistance from Govt. share for procurement of

machinery for which they applied.

Signature of the President/ member, GP (Name and Seal) The application and enclosed documents are scrutinised properly and recommended for allotment of

.................................... under ............................................... Scheme and forwarded to EE (Agri) /AEE(Agri)

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

Seal & Signature of ADO

N.B.: Incomplete applications will be summarily rejected.

Annexure-II

SCORING SHEET

1. Name of the ASG/ PPS/ JLG :-

2. Net Cultivable area of the FMC/ PPS :-

Sl. No.

Item/Subject Group members Score Marks obtained

1. Presence of qualified member in the

group

(a) Under Graduate ≥ 50% 4

(b) Graduate ≥ 50% 5

(c) Post graduate ≥ 50% 8

2. Presence of weaker section (ST/SC)

in the group

(a) ST ≥ 50% 5

(b) SC ≥ 50% 5

3. Involvement of woman farmer in the

group

(a) Women (widow/ unmarried/ only earning member of the family)

≥ 50% 8

4. Area of cultivable land under possession

(a) < 2 bigha ≥ 50% 5

(b) < 5 bigha ≥ 50% 4

(c) < 10 bigha ≥ 50% 3

(d) < 15 bigha ≥ 50% 2

5. Crop intensity

(a) <100 5

(b) <150 4

(c) <200 2

6. No. of farmers having KCC/ PMJDY

SB a/c in ASG

≥ 50% 10

7. Sub group of a PPS or FMC 10

8. Bank account in the name of ASG 10

Scored by

Junior Engineer, (Agri) Assistant Agricultural Engineer

(Full Signature)

Seal

(Full Signature)

Seal

ANNEXURE-V

INSPECTION REPORT/ SATISFACTORY CERTIFICATE OF RECEIPT OF Tractor/ Power

Tiller/AGRIL. MACHINERY

Scheme..........................................................................

Name of Machinery..........................................................

Sanction No................................................................... Dated........................

Brand ……………..………………………………. Model ………………………….…………… bearing

Engine No. ………………………………. Chassis No. …………………………………… (choose which ever

is applicable) of …………………………………………(name of machinery) is tested and found to be

in accordance with Departmental approved specification.

The trial run of ………………………………………… (name of Machinery) has been done by

undersigned in presence of beneficiary group on this ………………… day ………………….….

Month ……………………. Year and performance found to be satisfactory.

All accessories and implements & related documents are handed over by the Dealer

& received by us in good condition.

Signature

President of ASG/ Individual

(Seal)

Signature

Secretary of ASG/Individual

(Seal)

Signature

Signature of J.E (Agri)

(Seal)

Countersigned by

Executive Engineer (Agri) / Asstt. Executive Engineer (Agri)

(Seal)

N.B. Three copies to be prepared

1. For the ASG

2. To be retained in office file for record.

3. To be attached with the bill

N.B. In case of individual beneficiary oriented programme the above content may be revised

accordingly

Annexure-VI

DEED OF AGREEMENT

This Agreement is executed on the …………………….day of …………..……….2016

at…………………..District………………………, Assam, in pursuance of sanction accorded by

the EE(Agri)……………………vide no…................................... dated………… providing

Tractor/Power Tiller/ Machinery under…………………. Distribution of Tractor in 125 LAC

/Distribution of Power tiller in 125 LAC / Intensive use of Mechanization and Technology to

Increase Agricultural Productivity ( Strike out whichever is not applicable) 2015-16 .

I, Sri…………………………..., Secretary, Pathar Parichalana Samittee (PPS)/ ASG namely

………………………… Vill.: ….…………….P.O.:………………PS:……………….. District:

…………………., Assam, received an allotment of Tractor/Power Tiller/ Machinery under the

scheme - Distribution of Tractor in 125 LAC /Distribution of Power tiller in 125 LAC / Intensive

use of Mechanization and Technology to Increase Agricultural Productivity ( Strike out whichever

is not applicable).

I/ We understand that the Agreement is executed for the benefit of farmers of …………………

PPS/ ASG to increase farm productivity by way of mechanization (by using Tractor/ Power Tiller/

Other Agril. Machineries, etc.) distributed by Agriculture Department.

I/ We, members of ………………… PPS/ ASG hereby resolve to abide by the following

terms and conditions.

Terms and Conditions:

i) Procedure and Guideline circulated by Agriculture Department from time to time for

implementation of the Scheme will be strictly adhered to by the members of the Group/ ASG/

SHG /Individual.

ii) The Group/ ASG/ SHG /Individual have received the Machineries with all accessories from

Agriculture Department at subsidy granted under Direct Benefit Transfer (DBT) platform and

remitted to my /our Account No. _________________, ________________ Branch,

________________Bank.

iii) The Beneficiary shall use the Machineries for agriculture purpose only and shall provide for

utilizing the same machineries by the members of the group /ASG/SHG and other needy

farmers of the neighboring village(s).

iv) The operation & maintenance cost of the Machineries will have to be borne by the members of

the group/beneficiary.

v) The beneficiary shall complete the Registration of the Tractor/ Machinery with the DTO

concerned within 15 days from the date of this Agreement.

vi) The beneficiary shall insure the Machineries with Nationalize Insurance Company within 15

days from the date of this Agreement.

vii) All the members of the Beneficiary will derive equal benefit from the Machineries.

viii) During the life span of the Machineries, the beneficiary shall not sale or transfer ownership of

the Tractor/ machineries with any other party.

ix) The Agriculture Department will take legal action against the beneficiary to recover the amount

of subsidy of the Machineries granted as Govt. share, if beneficiary sale or transfer the Tractor/

Machineries.

x) Officials of the Agriculture Department or any other Agency as authorized shall have right to

inspect the Machineries at any time to ensure its proper utilization and to take action for illegal

use or loss under prevailing laws.

xi) Any dispute arises will be amicably resolved by the Director of Agriculture Assam.

Witness:

1. Member of the Group

2.Member of the Group

Full Signature of Beneficiary/ Leader of the

Group

( Seal and Date)

Executed in presence of

EE(A)……………/AEE(A)…………….

( Seal and Date)

To be executed on

Non Judicial stamp

paper of Rs. 10/-

Group Photograph of beneficiary

Farmers of PPS/ ASG