*Indicates mandatory
:1. Owner Type *
:2. Name of Proprietor*
:2. Name of Managing Director*
:3. Relation*
:3. (a). Relation's Name*
:4 Gender*
:5 Date of Birth*

6.Permanent Address

:6.A State*
:6.B. Pin Code*
:6.C. House No,Street/Lane, Village , Post Office, etc.*
Correspondence Address

7. Correspondence Address

:7.A State*
:7.B. Pin Code*
:7.C. House No,Street/Lane, Village , Post Office, etc.*
:10 Mobile*
:11 E-mail*
:12 GST No*
:13 Mill Operated By *
Lessee Details

13. (g). Correspondence Address *

Mill Details

:14. Mill Name*
:15. Year of Establishment*
:16. Mill Type*
:17. Raw Rice Output per 8Hour shift (In MT) *
:18. Parboiled Rice Output per 8Hour shift (In MT) *
:19.A. Storage Capacity of Rice (in MT)*
:19.B. Storage Capacity of Paddy(in MT)*
:19.C. Source of Electricity *
:19.D. Source of Electricity Provider*
:19.E. Consumer Number Allotted by Electricity Utility*
:19.F. Power Rating of Mill in KW *
:19.G. Electricity Consumed During KMS() *
:19.H. Electricity Consumed During KMS ()*
:19.I. Electricity Consumed During KMS () *
:19.J Mill PAN Card No *
:19.K State Pollution Control Board licence No *
:19.L SPCB licence Valid Upto*
:20. RMC Licence no.*
:20.A. RMC licence Valid Upto *
:21. Registration No. from Inspector of Factories and Boilers *
:21.A. Registration No. from Inspector of Factories and Boilers Valid Upto*
:22.A Is Cross District *
:22.B. Is Active*

Mill Location

:1. District Name*
:2. Block / ULB Name*
:3. Tahasil*
:4. Police Station*
:5. Mauza*
:6. Khata no. *
:7. Plot no. *

Milling History

:23.A. Select Agency*
:23.B. Select KMS*
:24.A. Quantity Of Paddy Received*
:24.B. Quanity rice due*
:24.C. Quantity Rice Deliverd*
:24.D. Quantity Against which SD has Adjured *
Agency KMS Quantity of Paddy Received(MT) Quantity of Rice Due(MT) Quantity of Rice Delivered(MT) Quantity Against Which SD Has been Adjustment(MT) Action