Name*
Contact No.*
Alternative Contact No.
E-mail*
Education
Age (In years)*
Gender*---MaleFemale
Location of Land*
Road/Highway Connectivity---YesNo
Area to be cultivated under Herbal Farming ( in Acres ) in association with Patanjali*
Please provide any one of the below mentioned ID proof details Adhar CardVoter IDPassport No
Id No.
Address*
City/Tehsil/Taluka*
District*
State*---Andhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJammu & KashmirJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdisha (Orissa)PunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalAndaman and Nicobar IslandsChandigarhDadra and Nagar HaveliDaman and DiuLakshadweepDelhiPuducherry (Pondicherry)
Total Land (In acer)
Water / Irrigation Facility---YesNo
Name of nearby Mandi / Crop Market*
Any Other Information ( If Any )
