GOVERNMENT OF MANIPUR - Official Website of Department of Commerce

							Form No……………
                              GOVERNMENT OF MANIPUR
                       DIRECTORATE OF COMMERCE & INDUSTRIES
                                             ------------                              Affix two
                                      APPLICATION FORM FOR                            passport size
                                              STATE AWARD                             photographs
                        FOR OUTSTANDING MASTERCRAFTS PERSONS                          attested by a
                                    (HANDICRAFTS)                                       Gazetted
                                FOR THE YEAR 2012 – 2013                                 Officer


1.   Name of the Craftsman
     (in block letters) please keep a space
     after surname and name
2.   Male/Female
3.   Name of father/husband
4.   Age and date of birth
                                               Leikai____________________________________________
                                               _
                                               P.O._________________________P.S._________________
                                               __
5.   Address in full
                                               Dist._________________________Pin_________________
                                               __
                                               Ph.No./M.No._____________________________________
                                               __
6.   Name of Craft practiced
7.   Name of the craft sample submitted
8.   Name of the Guru or teacher from
     whom the craftsperson got
     knowledge/training
9.   Description/brief note of the Craft
     Samples submitted alongwith two
     photographs one for the sample and
     other photograph should be while
     making the craft by the artisan
     (without photograph entry will not be
     accepted) This must be given on
     separate sheet written in Manipuri or
     English stating history and process of
     making in not more than 2 pages
     (typed) duly signed by the applicant.
10. Price of the Craft Sample submitted




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                                             Under Matric   Under-graduate
11. Educational qualification                HSLC Exam.     Graduate
    Tick whichever applicable ()            Diploma in     Master Degree
    (attach certificates)                    …………...
12. Mention any outstanding work
    performed. Have any items purchased
    by the Temple Board/Museum/Art
    Gallery. If yes, attach certificate
13. Whether received any award/prize
    earlier. If yes, state details
14. Has the artisan imparted training?
    If yes, state numbers of craftspersons
    so far trained
15. Has the artisan participated/
    demonstrated in any Handicrafts
    Mela/Fair (Attach Certificate)?
16. Is there any State Award/National
    Award Winner in the family?
    If yes, indicate your relationship
17. Attach certificate from the concerned
    SDC/SDO/Ward Commissioner/
    Pradhan/Member/G.M. (DIC) to the
    effect that the sample is the actual
    product of the artisan as per format
    attached at appendix – A
18. Attach two copies of bio-data of the
    Craftsperson to be separately attached
    (to be typed) not more than 2 pages in
    Manipuri or English
19. State Income earned per month by
    practicing the craft (approximate)
20. Attach certificate (if any) from a
    reputed Institution or Craftsperson
    regarding the Craftsperson’s
    (applicant) ability in the Craft and
    his/her contribution to the
    development of the craft.
21. State number of days taken for
    making the craft sample submitted for
    State Award
22. Is there any publication/papers to
    his/her credit? If yes, attach a copy
23. Ability to evolve new designs



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24. State name of the training centre/
    Institute/ organization from where
    acquired knowledge of the Craft
    practiced
25. State social category
    SC/ST/OBC / General/                       SC                    ST                   OBC
    Minority/Physically Challenged
    Please tick whichever applicable ()      General                Phy. Ch.             Minority
    (attached certificate)
26. State any other details concerning the
    craftspersons, which are not
    mentioned in the above columns
    (if any)



       Place :
       Date :                                                    Signature of the Applicant

                                             Declaration
                 I,                                                                    Shri/Smt./Km
       ………………………………………….………………………..…..                                          S/o.    D/o,    W/o
       ……………………………..……………. do hereby declare and undertake that the item
       of Craft submitted by me …………….……………. (name of Craft) for State Award has
       been prepared entirely by me. I undertake that if any of the above statement/information is
       found false, I shall be liable for the action as deemed fit being taken by the competent
       authority.

                                             Full Name of the Craftsperson :

                                             Address :

                                             Signature with date :

       Note : 1. Incomplete form will be rejected without giving notice to the applicant
              2. Documents furnished by the applicant should be attested by a Gazetted Officer.



h.c.award. 12


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                                                                          APPENDIX-A



                          TO WHOM IT MAY CONCERN




         Certified that Shri/Smt/Km …………………………………………………………
s/o, d/o, w/o Shri/Smt …………………………………………………………….............
resident of ………………………… ………… ………… …… ………………………....
is known to me for the last ……... Years. He/she has been practicing the craft of ……...
……………… for the last ……. Years and craft sample(s) submitted by him/her for the
State Award for the year 2012-13 has been entirely prepared by him/her.


         He/She is not related to me.




Date                                               Signature:

Place:                                             Name :

                                                   Designation :

                                                   Seal




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