Settlement Form D

1. Weaver ID Card No*

2. Name of the Weaver*

3. Mobile Number*

4. Weaver's Photo*

Supported file types: .jpg, .jpeg, .png

5. Father's / Husband's / Guardian's Name *

6. Address *

7. Aadhaar No*

8. Pan No

9. If Registered under SSY(Samajik Suraksha Yojana) Yes/No *

If Yes, Provide the registration Number*

10. Bank A/C No. *

11. Name of the Bank with Branch *

12. IFSC Code *

13. Address of Loom Shed/Unit *

14. No of Looms in Operation *

15. Type of Product produced *

16. Total production of Fy {{fiscalYear}} (As on {{date}})*

17. Total Sales TurnOver of Fy {{fiscalYear}} (As on {{date}})*

18. Details of repairs/renovation Done For Looms/Loom Shed*

Name of repaired/replaced items*	Voucher No*	Date*	Price*	Voucher Attachment* Supported: .jpg, .jpeg, .png, .pdf	Actions

19. Amount claimed in Rs *

20. Have You received any incentive under Any State Or Central Government Scheme-(Y/N) *

If Yes, Provide the details of the scheme*

I, Sri/Smt hereby declare that above information is correct to the best of my knowledge and belief and I am not a part of any Primary Weavers Co-operative Society.

Application for One time financial assistance to the individual Handloom Weavers under West Bengal Handloom and Khadi Weavers Financial Benefit Scheme, 2024

Attachments