ANNEXURE 2

Registration Form for Contract Farming (To be duly filled and applied on the Applicants letter head). To, The Managing Director, Gujarat State Agricultural Marketing Board, Gandhinagar.

I/we request to register the Agreement made and signed for contract farming in prescribed form. Name of the Applicant ______________________ (Individual/partnership firm/ Coop. society/Ltd.Co. (To enclose necessary proof) 2. Address of the Applicant Registered Office Tel. No. Fax No. Mobile No. E-mail Id. 3. Details of Applicants Office: Name of Head Address of Proprietor/CEO/MD/ Regd. Chairman etc. of the Office/Head Organization Office Tel.No./Fax/Email :______________________ :______________________ : _____________________ : _____________________ : _____________________ : _____________________ Address of Branch office Tel.No.Fax /E-mail Head of Branch office. Signature of the Head. 1. :

4.

PAN/TAN No. Of the Applicant: _______________________ (To enclose copy of Last 2 yrs. Return) Applicants last 2 year Balance sheet (to enclose the Copy). Details of bank Account (To enclose last 1 yrs Bank Statement duly attested by Authorized person Of the Bank. Details of farmers farm under Contract Farming. Survey No. :________________________

5.

6.

:________________________

7.

:_____________________

Name of village

Area of the farm in Hectares

Taluka & Dist.

(To enclose duly attested copy of the 7/12 8(a) and No.6 or Hakkpatrak of the farm land) 8. The duration of Tripartite Agreement : From Dt. ______ to Dt. _______ 9 Details of the Commodity :_________________________ (As per the details given in schedule 1 of the agreement) Name of Type/Variety Quality/Grade Agreed Estimated Logistic

the of the Commodity Commodity

of the Commodity

price per kg/MT

Total cost of the of the produce. produce

10.

Detail of technical/financial :___________________ assistance to be provided by the contract Sponsor to Contract farmer. Detail of Crop Insurance : ______________________ (to enclose the copy of insurance policy) 12. Detail of Responsibilities of the Farmer during the contract period (to enclose the sheet if required) The system/schedule of payment to be made to farmer during the Contract period. (To add the sheet if required) Name of the APMC who is party to the Agreement Details of facility provided by APMC. :_______________________

11.

13.

:_______________________

14.

:________________________

15.

:________________________

16.

Rate and Amount of Market Cess : ________________________ of the Commodity under Agreement

17. Has the contract farmer taken any : ________________________Loan or subsidy (if yes, then enclose copy of sanction letter of the Bank)

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Has Contract Sponsor signed any Agreement under Contract Farming before? if yes, then to enclose the copy of the Agreement

: ________________________

19

Has any dispute related to Contract : ________________________ Farming arisen or pending with Any APMC of the State?if yes, then Give detail of the dispute. For registration of the contract agreement enclosed Pls find DD/ Cash No.________of Dt . _______ for Rs.200/- in words Rs. _________________ payable to Managing Director, Gujarat Agriculture Marketing Board drawn on ____________________ Bank.

20.

Signature of Applicant: ___________ Designation Company Seal : ___________ :

Declaration 1. I/we have studied properly all the provisions of contract farming laws of Gujarat Agricultural Produce Market Act, 1963, Rules of Gujarat Agricultural Produce Market Rules 1965 and internal rules of Gujarat Agricultural Marketing Board there under and condition of agreement of Contract farming and I/we shall abide by the same during the period of the agreement. I/We have understood that I/we shall comply with the orders/direction/resolution/circular of contract farming issued by the Managing Director, Gujarat Agricultural Marketing Board. I / we are aware that in the event of breach of law the Managing Director, GSAMB has the authority to cancel the registration. I/we clearly understand and assure that with this agreement I/we do not get the ownership of the farm. And I/We shall not be able to mortgage, lease, sub-lease, transfer, etc. the title / ownership of the farm and shall not carry any activity detrimental to or against the interest of the farmer.

2.

3.

4.

Place:

Sign of Applicant : __________

Date:

Name Address

: __________ : __________

Companys seal :