How to Complete the GATIDHARA Scheme Self-Declaration (Annexure-III): West Bengal

Executive Summary

This guide provides detailed instructions for completing Annexure-III, the mandatory Self-Declaration form for applicants of West Bengal’s GATIDHARA self-employment subsidy scheme. This is a critical legal document, not a simple application. It is a sworn statement where you, the applicant, declare the truthfulness of your main application and accept strict liability for any misinformation. This guide explains the legal significance of each clause, provides step-by-step filling instructions, and outlines the severe consequences of providing false information. By understanding and accurately completing this Annexure-III, you protect yourself from legal risks and solidify the foundation of your subsidy claim under the GATIDHARA Scheme.

1. Form Overview & Purpose

Form Details:

Name/Number: Annexure – III (Proforma of the self-declaration to be submitted by the applicant applying for subsidy under GATIDHARA Scheme)
Governing Scheme: GATIDHARA Scheme of the Government of West Bengal, Transport Department.
Primary Purpose: To serve as a legally binding affidavit that accompanies the main GATIDHARA application (Annexure-I). Its purpose is to:
1. Certify the truth of all statements made in the main application.
2. Accept finality of the authority’s decision.
3. Assume liability for civil/criminal penalties in case of false statements.
4. Declare previous loan history and current employment status.
Download Link: Access the official form: Download Annexure-III (GATIDHARA Self-Declaration).

Relationship with Main Application:

Annexure-I: The main application form with personal, financial, and vehicle details.
Annexure-III: The sworn self-declaration that validates Annexure-I.
Process: You must first fill Annexure-I. Annexure-III directly references it and cannot be completed independently.

Eligibility & Prerequisites:

You must have already filled and submitted (or be ready to submit) the main GATIDHARA application (Annexure-I).
You must be an unemployed individual enrolled in the Employment Bank, meeting the scheme’s income and category criteria.
You must understand that this is a legal document with penal consequences for false statements.

2. Before You Start: Core Understanding

This is Not a Simple Form: Key Legal Implications
Before writing a single word, understand what you are signing:

Liability Clause (Point 2 & 4): You agree to compensate the authorities and face civil or criminal proceedings if any information is false.
Finality Clause (Point 3): You forfeit the right to challenge the authority’s decision to grant or reject the subsidy.
Absolute Right Clause (Point 4): The authority can stop subsidy payment at any time if any information is found incorrect, even after initial sanction.
Financial History Verification (Point 6): You must truthfully declare your entire history of government scheme loans.

Essential Reference Information Needed:
To fill this form, you must have the following details from your Annexure-I application:

The date you submitted (or will submit) your main GATIDHARA application (Annexure-I).
The name of the State Transport Authority (STA) or Regional Transport Authority (RTA) office where you applied/submitted.
Complete details of any previous loans received under government self-employment schemes.

3. Section-by-Section Filling Instructions

Fill the form in clear, legible handwriting. Use a black or blue ballpoint pen.

Part 1: Applicant Identification (Preamble)

Sri/Srimati: Strike out the inapplicable title.
Name: Write your full name as in Annexure-I.
Son/daughter/wife of: Strike out incorrect relations and write the name of your father/husband.
Residing at: Write your complete current residential address.
P.S.: Write your local Police Station.
District: Write your district.

Part 2: The Declaration Clauses (Points 1-8)
Fill each point carefully and completely.

Point 1: Enter the name of the STA or RTA office (e.g., “State Transport Authority, West Bengal, Kolkata” or “Regional Transport Authority, Howrah”) and the District where you submitted your main Annexure-I application.
Point 2: Enter the date of your main Annexure-I application. This links the two documents legally. Read this clause carefully—it is your acceptance of legal liability.
Point 3 & 4: No blanks to fill. These are standard legal clauses you must read and understand. Your signature at the end signifies acceptance.
Point 5: No blanks to fill. This is your commitment to abide by the loan agreement with the bank/financier.
Point 6 (CRITICAL – Loan History): You have two options. Choose ONE and strike out the other:
- Option A: “I have not received any loan from any bank/financial institute previously.” (If this is true).
- Option B: “I have fully repaid the loan received under ……………………..” Complete this with:
  - Name of the scheme (e.g., “Yuvasree,” “SGSY”).
  - Date you took the loan.
  - Name of the Bank/Financial Institute.
  - Last date of repayment of the final installment.
Point 7: No blanks to fill. This reaffirms your “unemployed” status as required by the scheme.
Point 8: No blanks to fill. This is your final certification of truth.

Part 3: Signing & Submission

Date: Write the current date when you are signing this declaration.
Place: Write the name of your city/town.
Applicant’s Signature: Sign in full, matching the signature on your Annexure-I and bank documents.

4. Submission Process & What Happens Next

How and When to Submit:

Timing: Annexure-III is typically submitted along with the main Annexure-I application as part of a complete application packet. Do not submit it separately.
Compilation: Staple or clip Annexure-III behind your Annexure-I form. It is a supporting document to the main application.
Submission Point: Submit the complete packet (Annexure-I + Annexure-III + all proofs) at the designated office mentioned in Point 1 of this form (STA or RTA office).
No Separate Fee: There is no separate fee for this declaration.

After Submission: Verification & Consequences

Background Verification: The authorities will cross-check every claim in your Annexure-I against the declarations made in this Annexure-III. This includes:
- Employment Bank status.
- Income certificate.
- Previous loan history (Point 6) through bank and government records.
- Community certificate.
Legal Scrutiny: This form elevates your application from an administrative request to a verified legal claim. Any discrepancy flagged during verification will be treated as a potential case of false declaration.
Potential Outcomes:
- If True & Correct: Your application proceeds for subsidy sanction.
- If False/Misleading: As per Points 2 and 4, your application will be rejected immediately. You may be blacklisted from future schemes, asked to repay any funds released, and may face criminal prosecution for fraud.

5. Critical Warnings, Tips & FAQ

Extreme Warnings:

Truth is Non-Negotiable: This is the most important form you will sign for the scheme. Absolute honesty is mandatory. The consequences for lies are severe and explicitly stated in the form.
Do Not Guess Loan History: If you are unsure about a previous loan’s status, contact the bank and get a No Dues Certificate (NDC) or closure statement before filling Point 6. Guessing incorrectly constitutes a false declaration.
Consistency is Key: Every single detail (name, address, dates) must exactly match your Annexure-I and attached proof documents. Inconsistency itself can be grounds for rejection under “untrue statements.”

Practical Tips:

Read Aloud: Before signing, read the entire form, especially Points 2, 3, and 4, aloud to yourself to fully grasp the commitments.
Keep a Copy: Photocopy the signed form for your records before submission.
Seek Clarification: If you do not understand any clause, ask the facilitating dealer or a legal advisor before signing.

FAQ Based on Form Content:

Q: What if I took a small personal loan from a bank, not under any government scheme?
- A: Point 6 specifically asks about loans from “any bank/financial institute.” You must declare it. The clause is broadly worded. Transparency is your safest policy.
Q: Can I submit Annexure-III later if I forgot it with my main application?
- A: It is highly inadvisable. The main application is incomplete without this declaration. The receiving office may not accept the main application or will ask you to resubmit both together. Always submit them as a set.
Q: What happens if my employment status changes (I get a job) after submitting this declaration but before receiving the subsidy?
- A: Point 7 states “I am still unemployed.” If your status changes, you have a legal obligation to inform the authorities immediately. Continuing the process would be a violation of your declaration.
Q: Is a witness or notary required for this self-declaration?
- A: The form does not call for a witness or notarization. Your signature is the binding element. However, the authority may have additional local requirements; check with the office.

Contact Information:
For scheme details and submission queries:

Official Website: West Bengal Transport Department – Check the “Schemes” section.
Scheme Facilitators: Contact the empanelled Dealer-cum-Gatidhara-Facilitator or the District Transport Office (DTO).
General Contact Guide: West Bengal Transport Department Contact Guide.

Final Advice: Treat Annexure-III with the same seriousness as a court affidavit. It is the bedrock of your trustworthiness for the GATIDHARA Scheme.