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2. Name of the Member: ________________________________ Sex: Male OBC/GEN Age: Unmarried _____years Marital Status: Married/ Female Caste/ Category: SC/ ST/
3. Name of the Farmers Club: _______________________________ 4. Address: Village: Block: 5. Family Composition: S.N o. Name of family member (member, M or nonmember, Nm) Relation with Head Age ( in years) Sex (M/F) Educatio n level Incom e (in Rs.) Contact No.:
1. 2. 3. 4. 5. 6.
6.
Land Holding Status: Before the FC Irrigated Un-irrigated Total Area After the FC Irrigated Un-irrigated Total Area
Holding Size Description Land Owned Land leasedin Land leased-out Orchard Land
7.
Livestock/ Poultry Ownership Details: S.No. Description of animal/ poultry Before the Program No. Possessed 1. 2. 3. 4. Milch Cattle Drought animal Poultry Others Value (in Rs.) After the Program No. Possessed Value (in Rs.)
8. Cropping Pattern:
TOH
Kharif
Rabi
Summe r
Particulars Machine ry and Farm Indigenous Equipme Plough nts Leveler Kudal Sprayer Phawra Fixed Assets Farm Building Cattle Shed Storage Compost Pit Vermicompost Others Scooter Motorbike Car/ 4-wheeler Mobile/ Telecommunicati on Television
Type
No.
Input Supplie r
Purcha se Price
Marke t Price
Other Assets
10. 11.
Yes
No
(a) Expansion of the existing business (b) Crop production purpose (c) Repayment of debt (d) House maintenance (e) To meet Family needs 12. Your approach for availing loan: (b) Bank with relatives and friends (d) Bank with moneylender
(a) Direct bank (c) Through FC (e) Bank with political leaders/ high officials 13. Preference of Bank Loan:
(b) Easy repayment facility (c) No other source of finance (d) Any other, specify 14. Loan Amount applied (in Rs.) Credit availing pattern: Loan Amount sanctione d Source Interest Cost (in Rs.) Noninterest cost (in Rs.) Type of Loan (ST/ MT/ LT) ________________________
15.
What was attitude of the bank in sanctioning the loan: (b) Discouraging
(a) Encouraging
18. What was the time gap between application and final disbursement of loan: (a) 1 month and above 19. (b) 2 months (c) 3 months (d) 4 months
(a) Rs. 4,000 and above 21. Credit utilization pattern: Amount sanctioned Cash Kharif Rabi Kind Amount Utilized Remaining Amount
Crop Season
22. Whether you are getting enough from the enterprise to repay loan on time: (a) Yes 23. (b) No How do you arrange money to repay loan on time?
(a) Borrowed money from friends and relatives (b) Taking another loan (c) Not repaying the loan regularly (d) Returns from the enterprise 24. 25. Your repayment status: Regular Irregular Default
(b) Insufficient income from enterprise (c) Crop failure (d) Multiple borrowing 26. Marketing Pattern and Marketing Cost:
Crop
Quantit y sold
Sale Price
Name of Agency
Marketing Expenditure
Market Price
27.
Is the FC member beneficiary of any other scheme? If yes, give details. ____________________________________________________________ ____________________________________________________________
28.
(a) Interest schemes (b) Subsidy (c) Technologies available in the vicinity (d) Prices of inputs available
Y/ N
Sources of Information about new schemes and latest technologies: (b) SAUs (d) Farmers Fair (f) Farmers Club
(a) KVKs/ VPKAS (c) Banking Officials (e) Media (f)Other Villagers 30. Trainings provided through FCP: (b) Credit orientation training
(a) BLOTP
(d) Others, specify ________________________________ 31. Has Farmers Club Been Effective in Performing these functions:
(a) Free medical camp (b) Monitoring of Developmental activities (c) SHGs formation (d) JLGs formation (e) Conducting a meeting in a month 32. Opinion on role of FCP in income generation: (b) Satisfactory (c) Not good for
___________________________________________________________________________ ___________________________________________________________________________