FORMAT-I

1) 2) Date of application Control No. : (to be given by NHB)

PHOTO

To, The Centre In-Charge National Horticulture Board ........................................................... ........................................................... (only projects upto Rs. 20.00 Lakh may be sent to this address) To The Managing Director National Horticulture Board Plot No. 85, Sector-18, Institutional Area, Gurgaon-122015 (Haryana) (projects above Rs. 20.00 Lakh may be sent to this address and a copy of the same to concerned State Office too)

Application for Letter of Intent (LOI) under the scheme Development of Commercial Horticulture through production and post Harvest Management of National Horticulture Board) A. GROWER/ENTREPRENEUR 1. Name :_________________________________ Permanent Address :_________________________________ Postal Address :_________________________________ 2. 3. 4. 5. Category : SC/ST/OBC/Ex-Service Man Gender : Male/Female ___________ Age _______ Occupation: Promoters/beneficiary profile i) Principal Promoter/Beneficiary ii) Others iii) In case of companies Registration number & date of registration Registering authority Act under which Registered Authorized share capital _________ Paid-up share capital _________ Reserves & surplus _______
(by end of last financial year)

B. PROPOSED ACTIVITY (Cultivation/PHM/Primary Processing/Horticulture ancillary) 1. Name of the Project 2. Location: Survey/Khasra No.___________ Village ___________, Taluka _______, District _________, State ___________

3. Activity proposed under the project in details:(a) Area under cultivation/project

Name of the Crops i) ii) iii) iv) v) Variety(s) Area ( acres ) No. of plants Source of Planting Material .................... ..................... ................... .................... ..................... ................... .................... ..................... ................... .................... ..................... ................... .................... ..................... ................... . . . ..................... ...................... . . . . .

b) c) d)

e) f)

PHM Activity - Grading & packing/Pre-cooling/Refer Van:Primary processing - Activity in brief with details of products:Horticulture ancillary industry e.g. tools, equipments, plastics, packaging etc. - Activity in brief :Misc. activities (Not covered in a to d) - Activity in brief :Refer Van/Specialized Transport Vehicle Yes/No

B.II (a) Whether proposed activity in application is a completely a new activity

(if No, the details of pre-existing activity or any component thereof included in the application should be indicated clearly)

..................................................................................... ..................................................................................... (b) Whether any subsidy has been availed Yes/No for the proposed proposal/activity from Central Govt. or any of its Agencies.

(if YES, please indicate clearly in detail ..................................................................................... ..................................................................................... C. PROPOSED PROJECT COST (Component-wise) Component/Item (Proposed Cost) (a) Cultivation (Amount in Rs.) 1) Cost of Cultivation (i) Cost of planting material .......................... (ii) Cost of fertilizer & manure .......................... (iii) Source of planting material & . proposed variety(ies) (iii)Cost of insecticides & pesticides (iv) .......................... Cost of labour ..........................

(v) Other expenditure, if any (pl. specify) .......................... 2) Irrigation (i) Bore-well/Tube-well (new/old) (iii)Cost of pipeline (length, diameter & type of material used) (iv) (existing/new & size) (v) Other expenditure, if any (pl. specify) .......................... .......................... ..........................

Water harvesting pond ..........................

3) Micro Irrigation, use of plastic mulching etc. (i) Cost of drip irrigation (ii) Cost of sprinkler (iii) Cost of plastic mulching (iv) specify) .......................... .......................... .......................... .... Other expenditure, if any (pl.

4) Infrastructure (i) Pump House (ii) Store (iii)Labour quarter .......................... .......................... ..........................

(iv)

Generator room

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

(v) Other expenditure, if any (pl. specify) .......................... 5) Cost of Tractor & accessories ..........................

[If area under cultivation (project) is above 05 acres] 6) Land development (including digging of pit & fencing.......... 7) Cost of Land, if purchased 8) Creation of controlled atmosphere a) Green house/poly house (size) b) Shade net (size) .......................... Area (sq. mtrs) Cost .................. .................. ............. .............

Total ....................................... (b) Post Harvest Infrastructure 1. Cost of grading/packing house .......................... 2. Cost of grading/packing line .......................... 3. Cost of pre-cooling unit (capacity) .......................... 4. Cost of refrigerated van (capacity) .......................... 5. Zero Energy Cool Chamber ... 6. Other components, if any (pl. specify) .......................... Total ........................... (c) Primary Processing 1. Cost of civil constructions .......................... 2. Cost of plant & machinery .......................... 3. Other components, if any (pl. specify) .......................... Total ............................ 4. Name the product of primary processing D. PROPOSED MEANS OF FINANCE (i) Promoters share .......................... (ii) Bank/FI term loan .......................... (iii)Proposed subsidy from other sources, if any .......................... a) Form State Govt. .......................... b) From Central Govt. other than NHB .......................... Total ...........................
(Note: Unsecured loans from friends/relatives will not be treated as equity)

Expected back-ended subsidy from NHB: Rs.

(NHB subsidy will be considered as per Boards guidelines, if found in order, but not guaranteed)

(e) Expected return/income from the proposed project. a) In case the project cost is above Rs. 10.00 lakh, a brief project report containing technical feasibility and financial viability should be enclosed alongwith application .............................................. b) In case of project cost is up to Rs. 10.00 lakh, the information pertaining to cash flow from the proposed project may be given as under : (Amt. in Rs.)
Year Expected Gross Income Expected Expenditure on fixed/ capital assests (excluding) repayment of loan+interest) 3 Expected Total Working expenditure operating (3+4) expenditure Estimated Net Income (2-5)

1 1st year 2nd year 3rd year 4th year 5th year ........... ...........

E. EXISTING STATUS OF PROJECT

(Please give details about the activities of the proposed project already completed at the time of submission of application of Letter of Intent (LOI)

............................................................................................... ............................................................................................... ............................................................................................... G. Whether any assistance in the form of soft loan and subsidy has been availed by the beneficiary earlier from the National Horticulture Board? If yes, give details thereof. ...............................................................................................

............................................................................................... H. Whether any subsidy has been availed from the Board, other Central Govt. organization or State Govt. for the same activity on same piece of land, khasra no. etc.? ............................................................................................... ............................................................................................... Details of subsidy, if availed from: (i) (ii) (iii) (iv) (v) (vi) MFPI APEDA NHM Technology Mission National Bee Board (NBB) : : : : :

AYUSH (Ministry of Health & Family Welfare) :

I. Name of the Bank/FI from where the term loan is availed/to be availed by the Beneficiary (Please enclose a copy of the duly filled up term loan Application). a) Name of Bank: ...................................................................................... b) Details of Bank Branch: . c) Bank Code:... J. Date & Amount of sanction of term loan, if any : ______________________ ______________________

K. Details of release of term loan, if any: L. DETAILS OF LAND I) Whether own land (ancestral) ii) Whether own land purchased iii)Whether leased If so, how many years lease : : :

_________________________ _________________________ _________________________

iv) Whether lease/tenancy/contract is registered with the Competent Registration Authority

(copy of the proof of each title be enclosed) M. IMPLEMENTATION SCHEDULE OF PROPOSED ACTIVITY i) Proposed month for undertaking land development: ii) Proposed month for plantation: iii)Expected date/month of first commercial crop: iv)Proposed date for start of unit in case of processing: N. MARKETING OF PRODUCE Details of marketing tie-up (Backward/forward linkage) O. Cost of Application Form & Scheme Brochure will be as under:
Projects costing upto Rs. 10.00 lakh Projects costing above Rs. 10.00 lakh and below Rs. 20.00 lakh Projects costing above Rs. 20.00 lakh and below Rs. 50.00 lakh Projects costing above 50.00 lakh : Rs. 1000/: Rs. 2000/: Rs. 5000/: Rs. 10000/-

The above prescribed cost of application form and brochure will be non- refundable.

P. Please remit the cost of application and scheme brochure by Demand Draft drawn in favour of National Horticulture Board payable at Gurgaon (Haryana) for projects costing Rs. 20.00 lakh & above and at concerned state office where project cost is below Rs. 20.00 lakh. Name of the issuing Bank Branch ................................ Q. Demand Draft No. & Date ............................... Amount(Rs.)

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

Name & address of consultant who prepared the project report (DPR).

Certified that the information/contents as above furnished by me/us in the application are true to the best of my/our knowledge & belief and nothing material has been concealed. In case, any information furnished in the application is found false, my/our application may be rejected out rightly at any stage by the Board. (Signature of the Beneficiary) Name & Address : ......................... Place: Date : Telephone/Fax No. .........................

Enclosures: i) Attach copy of record of right over project land. ii) Affidavit in prescribed format only. iii) Prescribed cost of application form and scheme brochure. iv) Detailed Project Report (DPR) - wherever applicable iv) Duly filled up and signed bank term loan application form/bank consent letter v) Copy of last Income Tax Return, if any. vi) Key map of project land showing project details and land boundary details. vii) NOC issued by Cooperative Society/Partnership Firm, if applicant is covered by Para- 5(h) of Guidelines No.1/2008. viii) Proof of identity of applicant (refer Para of 3 Guidelines No. 1/2008.) ix) In case project include item of 'Primary Processing' for manufacturing 'Fruit Products" covered by FPO 1955 then NOC issued by MFPI, Govt. of India be enclosed.

FORMAT II AFFIDAVIT (on stamp paper of Rs. 20)

I/we . (Name of the promoter/Director) Age___ son of Mr. (fathers name) resident of . (residence address) do hereby solemnly affirm and declare as under:
1. That I/we am/are individual grower/promoter/director/partner/group of growers/association of growers/proprietor of M/s..(name of beneficiary) having its Registration no. . Registered office at .. (office address of beneficiary). 2. That I hereby make application and I am duly authorised in my own right/by management vide its resolution no. .dated .. to apply and sign all required documents including this affidavit on behalf of company/partnership firm/cooperative society named as . ; and am fully aware of the facts relating to the setting up the project at Survey No. .. Village . Tehsil.District.. State(location of the project) for (activities to be undertaken by project) and application is being made to NHB for seeking Letter of Intent (LOI) under the scheme Capital Investment Subsidy Scheme for Construction and Modernization of Cold Storage and Storages. 3. That the term and conditions of the scheme of NHB under which an application is made by the applicant have been properly read and understood by me and I affirm that the project/proposal/scheme comply with the terms and conditions of NHB and the application is made in the correct applicable scheme. 4. That the proposed activities to be undertaken by the project/proposal scheme are covered under the above scheme of NHB and no part of the scheme/infrastructure of the project is designed or assigned to be used for any activity other than the horticulture activities specified in the applicant at present or in the near future. 5. That the information provided in the application of Letter of Intent (LOI) is true and correct to the best of my knowledge and belief. The estimate of the cost of project/proposal/scheme; financial viability and operating results have been worked out/computed as per the rule and generally accepted principle and norms in this regard. 6. That no subsidy /grants-in-aid other than shown in application form has been availed by the promoters/directors/proprietors for this new project and component thereof from Central Govt. or any of its agencies Except the NHB.

7. That myself or any other promoter of Cooperative Society\, partnership firm self help group has not availed any subsidy from NHB which has not been disclosed in the application. 8. That I/we also solemnly affirm that the proposal activity in the application for LOI is a completely new activity and not a pre-existing activity or any component thereof. 9. That I have thoroughly examined notification F. No. 45-64/2010-Hort dated 25.02.2010 for prescribed technical standards w.e.f. 01.04.2010. 10. That I accept and undertake that the Technical Scrutiny of the documents by NHB or its empanelled agencies shall not in any way obviate the responsibility of the Promoter/deponent, to scrutinize his project and insure that it invariability complies to the prescribed technical standards w.e.f. 01.04.2010 vide notification F. No. 45-64/2010-Hort dated 25.02.2010. 11. That in case of concealment of any facts in this regard, the Board would have right to reject my application out rightly at any stage.

DEPONENT

VERIFICATION
Verified on solemn affirmation at .. (Place) on this .. (date) of, .. (month), 2010 that the content of the above affidavit are true to the best of my knowledge and belief and nothing material has been concealed.

DEPONENT

(Self Certification Format to be obtained on a stamp paper of Rs.100)

DECLARATION
I . (Name of the Consultant) Age .... son of Mr. (fathers name) resident of . (residence address) certify that:
1. That I am a graduate engineer and have adequate experience / expertise in designing, Constructing and commissioning cold stores, insulation & cooling system and cold chain infrastructure equipment. That a copy of my graduation / post graduation certificate of B.E. / B. Tech / M. Tech is enclosed and shall form part of my certification and declaration. That I am the project / Technical Consultant and have been hired by the project promoter________________________ to design, conceptualize and prepare the project DPR bearing Ref. No.____________________. That I am fully conversant with relevant codes and standards applicable to the cold chain infrastructure and affirm invariable compliance of the project to the above mentioned prescribed Technical Standards. That I have thoroughly examined notification F. No. 45-64/2010-Hort dated 25.02.2010 for prescribed technical standards w.e.f. 01.04.2010. That I certify that the components of insulation and refrigeration systems in the prescribed format of the technical data sheet conform the ratings and performance of selected equipments and proposed design as per the prescribed Technical Standards w.e.f. 01/04/2010 vide notifications F. No. 45-64/2010-Hort dated 25.02.2010. That I undertake to adhere to the requirements of confidentiality and non-compete with respect to proprietary information entrusted to me by the promoter/manufacturer of equipment / the Board.

2.

3.

4.

5.

6.

7.

8.

That I will assist the Government inspection and regulatory agency during stage inspection of the project and provide any/or all technical clarifications as and when required. That I will furnish a certificate of satisfactory commissioning of the cooling system in conformance to the performance indicators as per the prescribed standards. That in case of any concealment of facts by me in the DPR with respect to invariable compliance to Technical Standards or on any instance of false declaration / certification by me or any part of my declaration is found to be incorrect, the Board may, in its discretion, take any actions (including legal action) against me as deemed fit and proper.

9.

10.

IN WITNESS WHEREOF, the consultant has signed this declaration and certification on this ____ day of ____ 2010 in the presence of the following witnesses; WITNESSES: 1.

(Sign of the Consultant) 2.