Interview cum Appraisal Form for finance against Warehouse Receipts

1. Which crop produce is stored?

Sl.No. Name of the crop Quantity Market Value
1
2
3
4
5

Sl.No. Warehouse/Cold Storage Receipt No. Name of State/Central Warehouse Corporation/Private godown issued the Receipt
1
2
3
4

Whether our lien is marked on Warehouse receipt : Y/N

If the warehouse/cold storage receipt is from private unit, : Y/N
is it approved by Regional Office/Zonal Office/Central Office

2. Proof of land record or lease agreement.

3. Declared that produce is free from any kind
of charge to others

4. Total value of all the produce :

Margin 25% :

Net eligible loan :

Terms of Repayment proposed :

Signature of Appraising Officer Signature/Thumb impression
Of applicant(s)