Farmer Self Registration – SAMRAKSHANE FARMER PRODUCER COMPANY LIMITED

Public Registration Form — Fill in your details to register as a member of SAMRAKSHANE FARMER PRODUCER COMPANY LIMITED.Your application will be reviewed and approved by the FPO office.
ఈ ಫಾರ್ಮ್ ಭರ್ತಿ ಮಾಡಿ ಸಲ್ಲಿಸಿ. ನಿಮ್ಮ ಅರ್ಜಿಯನ್ನು ಕಚೇರಿ ಪರಿಶೀಲಿಸುತ್ತದೆ.

1Farmer Details

2Family & Nominee

👤 Personal Information | ವೈಯಕ್ತಿಕ ಮಾಹಿತಿ

Branch *

Full Name *

ಹೆಸರು (Name in Kannada)

Father / Husband Name

Date of Birth

Gender *

Marital Status

Category

Education

Occupation

Religion

Aadhaar Number

PAN Number

Mobile *

Alternate Phone

Annual Income (₹)

Registration Date

Farmer Photo

🖼️ Gallery

📍 Address Details | ವಿಳಾಸ

Address Line 1

Address Line 2

PIN Code

Village / Town *

Hobli / Mandal

Gram Panchayat

Taluka / Tehsil

District *

State *

🌱 Land & Crop Details | ಭೂಮಿ ಮತ್ತು ಬೆಳೆ

Land (Acres)

Survey Number

Land Type

Main Crop

Irrigation Source

🏦 Bank Details | ಬ್ಯಾಂಕ್ ವಿವರ

IFSC Code

Bank Name

Branch Name

Account Number

Account Type

Bank Passbook / Cheque Photo

🖼️ Gallery

📄 Documents | ದಾಖಲೆಗಳು

Aadhaar Front

🪶

Upload Aadhaar Front

Image or PDF

Aadhaar Back

🪶

Upload Aadhaar Back

Image or PDF

✍️ Signature / Thumb Impression | ಸಹಿ

Upload from Gallery🖼️ Choose from Gallery

Draw Signature

Take Photo / Preview

👪 Family Members | ಕುಟುಂಬ ಸದಸ್ಯರು

Add all family members living in the same household. ☑ Click the Nominee radio button on the row to designate that member as the nominee.

#	Name *	Relationship	DOB	Gender	Aadhaar No	Occupation	Education	Dependent	Nominee ☑

🏆 Declaration | �WF0;ಷೋಷಣೆ

I hereby declare that the information provided above is true and correct to the best of my knowledge.I agree to abide by the rules and regulations of SAMRAKSHANE FARMER PRODUCER COMPANY LIMITED.