Father s Name/Husband s Name:... Permanent Address:......

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1 Regd No.:135/JPR/96-97 Hahnemann Charitable Mission Society ISO Certified Organization 301, Mahaveer Nagar II, Maharani Farm, Durgapura, Jaipur, , Rajasthan (India) Ph no: , Fax: Mail ID: REGISTRATION FORM Sr. No Date:. Name:... Paste your recent Father s Name/Husband s Name:.... passport size self attested color photograph Permanent Address: Post:....Village.. Tehsil:.... District.Pin code: Date of Birth:... Education:.. Professional Qualification and Experience... Caste:. Religion: contact:.... Contact No.: Home-...Mobile-. Alternate no-.. Specialization in Agriculture Occupation:...

2 What is Your Approximate Annual Income?... Why interested to registered with us(give in full detail)-.... Details of Experience, working with a NGO, If Any.. Work Detail How do you know about HCMS? Registration Fees: Rs 10,000 /- Only Payment mode: By DD or by direct deposition in our account. If DD then give its details: The Bank Details are as follows. Account Name :- Hahnemann Charitable Mission Society, Account Number : Name of the Bank :- Punjab National Bank RTGS/NEFT Code :- PUNB

3 Send us the below mentioned documents along with the filled application form* to us: 1. Copy of Resume including your experience details 2. Experience in Agriculture 3. Documents related to Education 4. Experience Certificates 5. Residential Proofs Please note that all the documents must be attested by Gazetted Officer (Government of your state) Rules and Regulations 1. Registration fee of the candidate will be non transferable and non refundable. 2. If any registered candidate wants to get beneficial use of government policies, in that situation only our consultancy service will be provided to him. All expenditure related to project and completion of essential formalities will be done by the candidate only. Approval of the project will depend on the concern department. Neither organization nor any employee of the organization will be responsible for it. 3. Registration fee will be acceptable only by Demand Draft. Draft will be payable in name of Hahnemann Charitable Mission Society, Jaipur. 4. All matter will be seen at jaipur jurisdiction only. 5. All rights are reserved by the organization. 6. Candidate must keep contact to head office by phone or personally after registration. Otherwise in any manner organization will not be responsible for any loss. Declaration I have gone through all rules and regulations related to registration and I am agreeing with these. I will pay all the expenditures and formalities by myself. All matter I am giving today dated.as per my own consideration, and I found it true and correct. I am here presenting these details by getting satisfied of all the rights of the organization. Signature... Date...

4 Regd No.:135/JPR/96-97 Hahnemann Charitable Mission Society ISO Certified Organization 301, Mahaveer Nagar II, Maharani Farm, Durgapura, Jaipur, , Rajasthan (India) Ph no: , Fax: Mail ID: SERVICES OF THE ORGANIZATION Hahnemann Charitable Mission society Provide these Services to the farmers/growersr Development of Agriland information Information related to medicinal/horticulture farming and herbal industrial units Soil/water testing in our research institutes Prepare project reports and provide technical information of the report Supply high quality seeds / seedlings and also provide information about raw materials to the industrial units Practical training for medicinal and horticulture plantation through our professionally skilled agriculture experts Time to time Crop testing through our agriculture experts Information about bank loans and other financial assistances Facility of agriculture insurance (possible crops only) Buy back agreements of the crops (On stamp paper of Rs.100) Laboratory test reports certifying their quality

5 Farmer s registration requires the following testimonial Agriland Document Trace Map Photographs-2 Identity Card Copy Ration Card Copy Stamp Paper of Rs.100/- for agreement purpose Soil and Water Test Report Consultancy/ Service Charges We charge Rs 10,000/-for one time registration fee and following consultancy charges. These are details of our consultancy/ Service Charges (Per Acre/ Year). It s Mandatory to take Our services for three years. State Plant/ Crop Fee Remark Rajasthan Jatropha 2000 Rajasthan Gavarpatha/Alovera, Ratanjoot (Bio-Desil) Anwala, Safed Moosali, Arrandi, 5000 Minimum Land Should be 5 Acre Ashwgandha, Pattharchur, Lemon Grass, Gugal, Maalti, Coonch, Jeevanti, Jojoba, Soonamukhi, Stivea, Mehandi, Kalihari, Isbagol, Neem, Sarpgandha, Tulsi, Mulethi, Milkthistal, Pachooli, Poodina, Benilla etc.

6 Uttar Pradesh, Haryana, Punjab, M.P., Gujarat, All Products 5000 Minimum Land Should be 10 Acre Other States All Products 5000 Minimum Land Should be 20 Acre Locations / Areas which are far more than 150 KM from Jaipur (Rajasthan), the grower or farmer will have to bear cost of transportation and accommodation of the Agriculture expert