.: Department of Animal Husbandry & Dairying, Haryana :.

FORMS & DOCUMENTS RELATED TO SERVICES / SCHEMES

1.	Application form for the Self Employment of Rural / Urban Educated Young Men / Women through Animal Husbandry & Dairying Department (Mini Dairy Scheme).
2.	Application Form (First Schedule) for registration under Milk & Milk Products Order, 1992.
3.	Form of Half Yearly Return (Fourth Schedule) under Milk & Milk Products Order, 1992.
4.	Application Form for registration under the Haryana Regulation of Compounded Cattle Feed, Concentrates and Mineral Mixtures Order, 1999.
5.	Application Form for renewal of Registration under the Haryana Regulation of Compounded Cattle Feed, Concentrates and Mineral Mixture Order, 1999.
6.	Application form for availing Loan/Subsidy under Calf Rearing/Piggery/Sheep Scheme of Special Livestock Breeding Programme.

Application form for the Self Employment of Rural / Urban Educated Young Men / Women through Animal Husbandry & Dairying Department (Mini Dairy Scheme).

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Applic ation Form (First Schedule) for registration under Milk & Milk Products Order, 199

Application Form (First Schedule) for registration under Milk & Milk Products Order, 1992.
FIRST SCHEDULE
Application for registration

[See Sub-Paragraph (1) of Paragraph 5]
PART I

PART I

1.	Name and Address of the applicant.
2.	Names of the Managing Director, Directors, Proprietors, Partners, Owners etc.
3.	Address of the business/dairy plant and of all the establishments/premises owned or managed by the applicant.
4.	Telephone Numbers/Gram/Telex
5.	(a)	Description of milk and milk products with quantities per year which the applicant is equipped to handle/control/process/manufacture. (Give full details)
	(b)	If already handling processing/controlling or manufacturing milk or milk product, the annual quantity of each product in the last three years (Give separately for each year)
	(c)	The quantity of each item of milk or milk product proposed to be handled processed or manufactured.
6.	Branches including chilling/collection centers.
7.	Installed per day capacity of the dairy plant.
8.	Total quantities of milk and each of the mil products handled or processed or controlled during the year.
9.	Average quantity of milk per day to be used or handled
	(a)	In lean season
	(b)	In flush season

PART II

DETAILED DESCRIPTION ABOUT COLLECTION OF MILK

1.	Geographical area proposed for the milk collection.
2.	Number of districts and villages from where the milk will be collected.
3.	Number of breed-wise milch cows, buffaloes, sheep or goat, district-wise in the area.
4.	District map showing taluka /Tehsil boundaries and major roads/rail roads etc.
5.	A brief description about the existing milk procurement, processing and marketing facilities.
6.	Milk producers’ cooperative societies/union etc – total and functional in the area of operation.
7.	Number of dairy plants – public/private in the area of operation.
8.	Any other developmental program.
9.	Input services provided to the farmers/proposed to be provided for milk production enhancement.
	I/we hereby undertake to comply with all the provisions of the Milk land Milk Product Order, 1992.
	Please find forwarded herewith the prescribed registration fee.
	I/we declare that the facts stated herein above and the particulars given in Parts II and I are true and correct.
	Signature(s) of the applicant(s)
	Place
	Date

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FORM OF HALF YEARLY RETURN (FOURTH SCHEDULE) UNDER MILK & MILK PRODUCTS ORDER, 1992.

FOURTH SCHEDULE

Half yearly Return

[See of Paragraph 14]

For the Period ending………..

Name of Dairy Plant/Unit/other

Establishment/Premises (with address)

Name of the holder of Registration Certificate				Town/District		State

Registration Number						Date of issue

Stock Position
				Fat (MT)		Solids-not-fat (MT)
Opening Stock
Receipts
Dispatches
Closing Stock
Milk Procurement
Source of Remarks Procurement	Type of milk	Total Qty. (MT)	Total fat (MT)		Total SNF (MT)		**Prices Rs/Kg of milk	**Prices Rs./Kg of fat	*Prices Rs./Kg of SNF
Village milk prod. Co-op societies	Cow Buffalo Mixed
Milk	Cow Buffalo Mixed
Other agencies	Cow Buffalo Mixed

** Annexe details regarding name, location etc. Indicate landed price of milk

MT - Metric tonnes

Rs/kg - Rupees per kilogram

Reasons for conservation of commodities

Total Half yearly (MT)
Commodities used for -------------------------------------------------------------------------------------
Whole milk powder Skimmed milk powder Butter Oil White Butter

Combined milk for sale
Other Milk Products
Product manufactured

#	Product	Qty. Produced (MT)	Average Product Qty. Fat/SNF (Mt.)	Average Fat/SNF
1.	White Butter
2.	Table Butter
3.	Ghee
4.	Skimmed milk powder
5.	Whole milk powder
6.	Infant food
7.	Malted food
8.	Chocolate products
9.	Cheese
10.	Any other article containing milk or milk product
11.	Ice Cream
12.	Yogurt.
	Qty – Quantity
	MT - Metric Tonnes
	SNF – Solid – not - fat

Milk sold directly	Packing	Total quantity	Average	Consumer

in towns (Name Iitre)	(Specify)	during the period (.00L)	Fat/SNF	(Ruppes per

Milk supplied to other	Total qty.during the	Average	Price (Rupees per litre)

PRODUCT MARKETING

Product selling	Opening Stock	Quantity sold during the	Closing Stock(Metric Tonnes	Average ex-dairy
(Rs/lit)		Period (MT)
1. White Butter
2. Table butter
3. Ghee
4.Skim milk powder
5.Whole milk powder
6.Infant food
7.Malted food
8.Cheese
9.Chocolate Products
10.Any other article containing milk or milk product
11.Ice-Cream
12.Yogurt
Signature
Place:
Date:

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Application Form for registration under the Haryana Regulation of Compounded Cattle Feed, Concentrates and Mineral Mixtures Order, 1999.

S. No. (Price Rs. 20 only)

ANIMAL HUSBANDRY & DAIRYING DEPARTMENT HARYANA
Application form for registration

Application for registration under the Haryana Regulation of Compounded Cattle Feed, Concentrates and Mineral Mixtures Order, 1999.

1.	Name of the Manufacturer/dealer and its proprietor along-with address
2.	Date of its establishment
3.	Area of premises of the manufactured / dealer to be registered
4.	Detail of machinery installed along-with their cost
5.	Name of the items manufactured / sold / distributed along with the specification being to be followed.
6.	Testing arrangement
7.	Whether registered as small scale Industry or not
8.	Approximate sale price of each item
9.	Production capacity/per day
10.	Actual production at the time of applying for registration
11.	Challan Number and date of the deposit of the fee.
12.	Staff ---
	Skilled/unskilled workers
	Technically qualified Supervisory/ inspectors
13.	Service, after sale arrangements
	Date:
	Signature of the manufacturer/dealer

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Application Form for renewal of Registration under the Haryana Regulation of Compounded Cattle Feed, Concentrates and Mineral Mixture Order, 1999.

FORM-IV
[See Clause 9 (ii)]
Application for renewal of Registration Certificate under the Haryana Regulation of Compounded Cattle Feed, Concentrates and Mineral Mixtures Order, 1999.

1.	Name and address of the registered manufacturer/dealer.
2.	Date of first registration.
3.	Number of quality tests performed during the last three years.
4.	Whether facility of quantity control availed from the Laboratory, if yes, number of test carried out.
5.	Whether facility of quality of any contravention of any provision of Haryana Regulation of Compounded Cattle Feed Concentrates and Mineral Mixtures Order, 1999? If yes, give details?
6.	Whether your licence has been suspended or cancelled at any stage?
7.	Quantity of each product manufactured/distributed, sold during the last three years (give details year-wise)
8.	Any addition made in the facilities of quality testing in the premises of manufacture during three preceding years?
9.	Number and date of challan, vide which the fee has been deposited and name of treasury.
10.	State, if renewal is required for all the products at specified in previous registration or an alteration is required to be made.
	Signature of the Applicant

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Application form for availing Loan / Subsidy under Calf Rearing / Piggery / Sheep Scheme of Special Livestock Breeding Programme.

funs'kky; i'kqikyu ,oa Msjh foHkkx gfj;k.kk
NksVs vkSj lhekUr fdlkuksa rFkk Hkwfeghu etnwjksa dks _.k@vuqnku nsus ds fy, izkFkZuk i=

izkFkhZ rFkk mlds firk dk uke

LFkkbZ irk % xkWao] Mkd[kkuk] rglhy o ftyk

,dM+ksa esa Hkwfe dk fooj.k

¼d½ izkFkhZ ds uke Hkwfe
pkgh @flafpr
xSj eqedhu Hkwfe ¼cUtj dnhe lfgr½
xSj eqedhu Hkwfe ¼cUtj dnhe lfgr½
ua 3 ¼d½ rFkk dk tksM+
¼[k½ ifr ;k iRuh ;k ukckfyax cPpks ds uke Hkwfe
pkgh
cjkuh Hkwfe ¼cUtj dnhe lfgr½
xSj eqedhu Hkwfe ¼cUtj dnhe lfgr½
uaa 3¼d½ rFkk dk tksM+
¼x½ 3 d rFkk ¼[k½ dk tksM+

D;k vkids ikl buds vfrfjDr vkSj nwljs xkao esa ;k gfj;k.kk ds fdlh vkSj ftys esa Hkwfe gSa ;fn gS rks fooj.kk ns 1

D;k Hkwfe jgu gS ;k ugha A ;fn gS rks jgu Hkwfe dk fooj.k nsa A

;kstuk ds fy, dtkZ ,oa vuqnku pkfg, A _.k dh jkf'k] vuqnku dh jkf'k tksM+

1	ladj cNM+h ikyu ds fy,
2	eqxhZikyu ds fy,
3	lwvj ikyu ds fy,
4	HksM+ ikyu ds fy,

D;k vki eqxhZikyu@lwvj ikyu esa izf'kf{kr gSa A

okf"kZd vk;	d`f"k ls	vU; lk/kuksa ls	tksM+	vk; dk fooj.k :0 esa

D;k vki vuqlwfpr@fiNM+h Js.kh ls lEcU/k j[krs gSa A
;fn gkWa rks ml tkfr dk uke

10.

D;k vkius igys dHkh fdlku ;kstuk@fdlh nwljh laLFkk@
foHkkx ls dtkZ fy;k gS A ;fn fy;k gks rks fooj.k nsa A

11.

D;k vki lgdkjh lfefr ds lnL; gSa A

12.

D;k vkius xzke lgdkjh lfefr dks dtkZ nsuk gS A

;fn mRrj gkWa esa gks rks fooj.k nsa A

eSa 'kiFk ysdj ?kksf"kr djrk gwWa fd eSa i'kqikyu foHkkx ,oa dtkZ laLFkk ds fu;eksa o 'krksZa dk ikyuk d:Waxk vkSj mi;qZDr lwpuk esjs Kku vkSj fo'okl vuqlkj Bhd gS vkSj dqN ugha Nqik;k x;k gS A eSa ?kksf"kr djrk gwWa fd tks lwpuk dkye 3¼d½] ¼[k½] 4] 5] 7] 8] 9] 10] 11 vkSj 12 esa nh xbZ ;g lR; gS A

eSa ;g Hkh /kks"k.kk djrk gwa fd tks Hkwfe mi;qZDr QkeZ esa ntZ dh xbZ gSa ml ij esjk vf/kdkj gSa vkSj ml ij vius vki dk'r djrk gwa 1

ljiap

iap@uEcjnkj ds gLrk{kj ftldh mifLFkfr ds izkFkhZ uss gLrk{kj fd,

izkFkhZ ds gLrk{kj ;k
fu'kku vxwaBk

uke

xkao

rglhy

fnukad

;g izek.k i= Hkwfeghu etnwjksa ds fy, gS

izekf.kr djrk gaw fd izkFkhZ dk xkao esa viuk edku gS vkSj mldh d`f"k etnwjh ls vk; 50 izfr'kr ls vf/kd gSa !

iVokjh@QhYM lgk;d@xzke lfpo ds gLrk{kj

dkye u0 3 lEca/k esa iVokjh dh fjiksVZ

lR;kfir ,oa izekf.kr fd;k tkrk gS fd izkFkZuk i= esa ntZ lwpuk Bhd gS A

izekf.kr fd;k tkrk gS fd izkFkhZ fuEufyf[kr dk

Hkwfe jktLo vfHkys[k vuqlkj esjs ljdy esa Hkwfeifr gS %& vkSj Jh &&&&&&&&&&&&&&&&&&&

,dM+ksa esa Hkwfe	,dM	duky	ejyk
¼d½ izkFkhZ ds uke Hkwfe ¼1½ pkgh@flafpr Hkwfe ¼2½ cjkuh Hkwfe ¼catj dnhe lfgr½ ¼3½ xSj eqefdu Hkwfe ¼catj dnhe lfgr½ ¼[k½ ifr] iRuh ;k ukckfyx cPpksa ds uke Hkwfe ¼1½ pkgh@flafpr Hkwfe ¼2½ cjkuh Hkwfe ¼catj dnhe lfgr½ ¼3½ xSj eqefdu Hkwfe				Lqkiq= &&&&&&&&&&&&&&&&&&&& xkWao &&&&&&&&&&&&&&&&&&&& rglhy&&&&&&&&&&&&&&&&&&& tks fd dksVk@lhekUr fdlku@Hkwfeghu etnwj gS A vuqnku nsus ds fy, flQkfj'k dh tkrh gS A {ks=h; Ik'kq lgk;d fpfdRld ds gLrk{kj Ik'kq fpfdRlky;&&&&&&&&&&&&&&& ftyk &&&&&&&&&&&&&&&&&&&&& fnukad &&&&&&&&&&&&&&&&&&&&&&&&
¼d½ rFkk ¼[k½ dk tksM+

izkFkhZ ds ikl esjs ljdy esa fdlh nwljs xkWao esa dksbZ Hkwfe ugha gS A Hkwfe ij dksbZ cU/ku¼jksd½ ugha gS vkSj izkFkhZ Hkwfe ij [kqn dk'r djrk gS vkSj dkye ua0 5 esa jgu Hkwfe dk fooj.k Hkh Bhd gS A

iVokjh ds gLrk{kj ¼frfFk lfgr½
ljdy dk uke
fnukad

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