Self Help Group Information

State name District name Block name

Odisha Ganjam Surada

Gram panchayat : Village: Self Help Group name: SHG type: New/ Revived/ Pre NRLM Date of formation: Promoted by: NRLM/SGSY/State Project/ NGO/ Any Other Project Bank details Bank name : Bank branch name: Savings bank account number: Date of opening of account: SHG functioning details Micro-plan prepared: Yes/No Basic SHG Training: Yes/No Bookkeeper identified: Yes/No Standard Bookkeeping practices: Yes/No Meeting Frequency: Weekly (7)/ Monthly (30)/ Fort Nightly (15) Usual Amount of Saving (Per Member): No. of times Bank Linkage happened (Mention only the number of loans taken and repaid): -------------------------------------------------------------------------------------------------------------------- Certified that our members of group are not member in any other SHG. Signature of President with Seal Signature of Secretary with Seal

SHG Members Details

S.

NO

.

Member Name Father / Husband

Name

G

e

n

d

e

r

Social

Categ

ory

(SC/

ST/

OBC/

other)

Disabilit

y(No./

Self

Family

Member

)

Relig

ion

BPL

No.

PIP

Categor

y

(Poor/

POP/

NON

POOR)

Lead

er

UID/

Aadh

aar

SE

CC

No.

Mobile No.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

NCTIONING