PRADHAN MANTRI KISAN SAMMAN NIDHI (PM-KISAN) (REGISTRATION FORM)
16. Category (SC / ST / OBC/GENERAL):
17. Details of family members:
18. Details of Collective land holdings :
A) Type of land holding: Community Based / Private (Please specify):
B) Particulars of collective land holdings
*in case of community based/privately owned land holdings (prevailing in hill districts), the areas of such land holding/list of eligible beneficiaries/Exclusion criteria shall be certified/verified by the concerned Village Chief/ Chairman of Village authority by way of declaration for the beneficiary concerned indicating share out of the total area owned by the community/private and in such cases, CS Dag No & Patta No. may be dropped and name of joint owners may be indicated in place of Co-Pattadars. Such reports shall be authenticated by the SDOs concerned.
19. Bank details of the farmer/applicant
i. Name of the Bank Branch:
ii. Name of Account Holder:
iii. IFSC Code :
iv. Account number :
19. Exclusion Criteria:-
i) Former and present holders of constitutional posts: Yes/No
ii) All serving or retired Class-I/II/III officers and employees of Central/ State Government PSU/Local Bodies/ Autonomous Institutions under Government: - Yes/No
iii) Monthly pension more than Rs. 10,000/- per month:- Yes/No
iv) Income Tax Payee: Yes/ No
v) Former and Present Minister/State Minister/MP/Ex -MP/MLA / Ex-MLA / Mayor/Ex-Mayor/Zila Parishad chairman/Ex-Zila Parishad Chairman: - Yes/No
vi) Doctors/Engineers/Lawyer/Charted Accountant/Architects registered with professional bodies: - Yes/No
SELF- DECLARATION
I, Shri/Smt/Km.....................................
s/o,d/o,w/o,h/o........................................................................................................................................a resident of..... .............................under Tehsil:........
Sub-Division:......................... District:.............................. do hereby declare that I am a Small/ Marginal farmer having less than 2(two) hectare of total collective land holding(s) in the name of my family ; and therefore eligible for availing benefits under PRADHAN MANTRI KISAN SAMMAN
NIDHI
(PM-KISAN) Scheme.
2. That, all the statements made in the application form are true and complete to the best of my knowledge and belief and I understand that in the event of any information being found false or incorrect at any stage or not satisfying the eligibility criteria according to the requirements, my application is liable to be cancelled. That, I further declare that I do not fall under any of the exclusion criteria from being a beneficiary to the Scheme.
3. In case of incorrect self declaration made by me, I shall be liable for recovery of the transferred financial benefit and shall be liable to be punished as per law of the land.
4. ***Further, I also give my consent and agree that the department responsible for implementation of the Pradhan Mantri Kisan Samman Nidhi Yojana in the Union/ State Government can use the beneficiary Aadhaar number and other information provided to verify the eligibility of the undersigned for the Scheme.
Date: Signature / Thumb impression of the farmer:
Place: Name: Address:
FIELD VERIFICATION REPORT
Name of the Verifying Officer/ Official/ Authority:
Date of verification:
Statements verified and found to be: TRUE / FALSE on field verification.
Recommendation: ELIGIBLE/ INELIGIBLE
Remarks (if any):
Date: Signature of the Verifying Authority:
Place: Name:
*** Strike off if not applicable
Designation:
!. New Scheme fo r all small and marginal landho lding fanne r families owning up to 2 Ha of cultivable land are elig ible. The total of all land in different revenue villages must be less than 2 Ha.
2. Beneficiaries will get Rs. 6,000/ - per year in 3 instalments (@ Rs. 2,000/- per insta lment). The instalment fo r Dec 2018-Marth -2019 will be paid by March.
3. Cut-off date is pi February, 2019 No transfer of land, change of namc, etc. after this date shall be considered (except fo r change of name due to s uccession due to death) .
4. is defined as husband, wife and minor ch ildren. Husband , Wife or children cannot claim the bcl,efits separately In case of Joint Ownership of land by diffe rent re lated families, then they will be eligible if their sha res are less than 2 Ha
5. TenantslEncroachers entered in Dag C hitha are not eligib le.
6. Exclusion Criteria for fanne r families with onc or marc of ilS members belonging to one of the following:
i) Fonner and present holders of constitutional posts.
ii) Fonner & present Ministe rs, M Ps, MLAs, Chairperso ns of Munic ipal councils, Adhyaksha.
iii) Government employees (exc ept Grade-IV employees)
tv) Pen sio ners with monthly pension of Rs.IO. 000 o r more.
v) All persons who paid Income Tax in last assessment year.
vi) Professionals like Doctors, Engineers, Lawyers, ArchitcclS , etc ., carrying out profession by undertaking practices.
7. Documents required:
i) Updated Jamabandi (as of January 2019).
ii) Aadhaar Number or Aadhaar enrolment numbe r
iii) Other valid I-card like Driving Licence, Vo ters' 10 Card, NREGA Job Card (if Aadhaar not availab le).
iv) Bank detai ls (Account No.lBank Name & Branch, IFSC Code etc.).
v) I passport photo.