APPLICATION FORM FOR SHILP GURUAWARD2015
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- Marsha Arnold
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1 APPLICATION FORM FOR SHILP GURUAWARD2015 FOR MASTERCRAFTPERSON OF HANDICRAFTS SENDING DETAILS OF ENTRIES FOR THE SHILP GURU AWARDS 1. State Passport size Photograph attested by concerned AD of HM&SEC or WSC or RD PHOTOGRAPH AFFIXED 2. Recommending Agency 3. For the year Name & address of the Craftsperson in English Mob.No. &Tel.No/Fax/e.mail 5. Name of the Craftsperson in Hindi 6. Father s name in English Father s name in Hindi Spouse name in English Spouse name in Hindi 7. Place of Birth: Date of Birth ( please also furnish attested copy of document of date of birth) Age as on Name of the Crafts practiced Traditional or Contemporary Brief History of the Craft being practiced, attach separate sheet if required 9. Guru or teacher from whom the craftsperson got initiation and training 10. Total Experience as on from to 11. Educational/Vocational qualification, if any Degree of skill in the craft, if any 12. Mastery over the traditional technique involved in the craft
2 13. Ability to evolve new designs 14. Brief account of the Mastercraftspersons contribution towards development improvement of the Crafts and its techniques. 15. Details of outstanding works/item executed by the craftsperson/weaver. Have any of them been purchased by, Museum Temples, art critics, connoisseurs of repute Any documents to substantiate the claim? 16. Has the Mastercaftsperson imparted Training in any training institute. How many craftsperson of younger generation trained. 17. Details of the awards awarded to the applicant Mastercraftpersonviz National Award, National Merit Certificate and and State Aware. Sl.No. Name of the Award Year of the Award 18. Give details of other award winners in the family, if any, indicating your relationship with such Awardee. State Awardee indicating year, National Award indicating year of National Merit Certificate, indicating year. 19. Details of major exhibition in which the Mastercraftperson has participated either for demonstrating his skill or for displaying his creations. 20. How much does the Mastercraftperson earn every month approx. 21. Are there any publications/papers to his/her credit 22. Details of craft and exhibits of National Award entry along with 4 different stages of processing of the exhibits photographs minimum 8 X10 size.if possible videography of the process of the exhibits may be submitted. Minimum three samples should be submitted along with the entries of the craft practiced.
3 23. Price of the craft sample/sample submitted 24. Do the samples belong to the Mastercraftperson if not, to whom does it belong? 25. Certificate (if any) from well known Institutions or persons knowledgeable in Handicrafts regarding the Mastercraftperson s ability in the craft and his contribution to the development of the craft. 26. Details of recognitions, records, if any 27. Any other details concerning the craftsperson which have not already been brought out in other columns. 28. Total period taken for making the entry for National Award 29. Brief note in respect of the entry/product made for Shilp Guru (This must be given on separate sheet, in Hindi and in English duly signed by the applicant.) 30. Whether entry has been made entirely & solely by the applicant or has also taken assistance from other artisans. 31. If yes, details of assistance sought in the context. 32. If Govt. likes to purchase the item submitted, will you sell the same? 33. If yes, indicate the amount of selling 34. Affidavit regarding non-claim in case of damage to the sample NOTE: 1. INCOMPLETE FORM WILL BE REJECTED WITHOUT ANY NOTICE TO THE APPLICANT. 2. EXCEPT THE 1 st Class Magistrate AFFIDAVIT, ALL OTHER DOCUMENTS FURNISHED BY THE APPLICANT MUST BE ATTESTED BY AT LEAST A GAZETTED OFFICER. 3. PLEASE SPECIFY EACH DOCUMENT AND TOTAL NUMBER OF PAGES ENCLOSED WITH THE APPLICATION
4 CERTIFICATE: The entry/entries submitted with this application is/ are actually made / produced by the applicant master Mastercraftperson Son/Doughter /wife of Shri and affidavit to this effect on stamp paper duly signed by 1 st Class Magistrate is enclosed. (Signature of the Mastercraftperson) Phone No. with STD Code Mob.No. The particulars furnished in the application and in the enclosed documents have been checked and verified and I certify that the entry has been made by him/her and he/she is a genuine Mastercraftsperson. Signature of the Director/Deputy Director/DIC, Asstt.Director, HM&SEC, Deputy Director/Asstt.Director under whose jurisdiction the Name and Signature of certify officer with full address with rubber stamp Name and Signature of certify officer with full address with rubber stamp (To be filled in by the Convener of the SLSC in respect of only those applications which have been shortlisted by the Committee for next level Committee i.e Headquarter Level Committee. Certified that the bonafides of the applicant, his/her particulars as given in the application and other documents attached hereto including the skill level of the artisans has been re-ascertained/ verified. (Signature of the convener of the State Level Selection Committee) (Full name and address with rubber stamp)
5 AFFIDAVIT TO BE SUBMITTED ON STAMP PAPER BY THE CRAFTSMAN SUBMITTING HIS/HER ENTRY FOR COMPETITION OF SHILP GURU AWARD I Shri /Smt./Miss born on aged as on , S/o, W/o D/o Shri resident of solemnly hereby declare and undertake that the item (name of the item) Craft (Name of the craft) submitted by me for the competition of Shilp Guru Award for the year 2015 has been prepared entirely by me and I have been practicing the Craft (Name of the craft) for the last years for the period from to. I have been Awarded State Award in the field of handicrafts in the year National Aware in the year andnational Merit Certificate in theyear in the field of handicrafts or handlooms. I undertake that if the above statement is found false, I shall be liable for the action as deemed fit by the competent authority. I further undertake that I am submitting the above entry forshilp Guru Award 2015at my own risk and responsibility and further indemnify the Government of India, Office of the Development Commissioner (Handicrafts), Ministry of Textiles, State Governments, DICs, etc. against any loss, damage or theft to the entry which may occur due to any unforeseen circumstances and on account of handling and transportation of the entry. Full Name of the applicant Mastercraftperson: (To be attested by 1 st Class Magistrate) Address Signature with date
6 PROFORMA FOR SUBMISSION OF BIO-DATA FOR SHILP GURU AWARD Name (both in Hindi & English) : 2. Name of father/husband/spouse : (both in Hindi & English) 3. Place of Birth : 4. Date of Birth : 5. Address with PIN code : 6. Education/Training received : 7. Tradition of the Craft : 8. Total contribution (since when : working on the craft 9. Participation in India/Foreign Exhibition : 10. Any other important points : 11. Telephone No/Mobile No., /id (if any) : Note: 1. ATTACH BRIEF BACKGROUND NOTE ON CRAFT OR ITEM SUBMITTED STATING HISTORY & PROCESS OF MAKING. 2. ATTACH A BRIEF PERSONAL PROFILE OF THE APPLICANT CRAFTSPERSON/ WAEVER OF NOT MORE ONE PAGE (TYPED ) 3. THIS PROFORMA MUST BE FILLED BOTH IN HINDI & ENGLISH WHEREVER INDICATED Signature of the Artisans
7 श ल पग र प रस क र क शऱए आव दन फ मम हस तश ल ऩ क श द हस तश ल ऩ ह त श ल ऩग र ऩ यस क य क शरए प रव ष ट म क व यण ब जन क फ ध भ 1 य ज म फ धधत ह मक ननद क, हस त व ऩणन ए व स त य क न द र, फ न ई क न द र म क ष त र म ननद क द य त म वऩत ऩ ऩ ट आक य क प प ध ऩक म 2 श प रय कयन र एज 3 र ट क शरए श ल ऩ क न भ औय ऩत अ ग र ज म म ब इऱ/ट ऱ फ न नम बर/फ क स/ई-म ऱ 5 श ल ऩ क न भ ह द म 6 वऩत क न भ अ ग र ज भ वऩत क न भ हहन द द भ ऩ नत ऩत न क न भ अ ग र ज भ / ऩ नत हह द भ ऩत न क न भ/ 7 जन द भ स थ न जन द भ नत धथ क ऩम जन द भनतधथ फ ध दस त ज क ( ) नत प रस त त कय णणत प र अन प रभ क आम 8 ष ज श ल ऩ ऩय क मट कय यह ह उ क न भ ऩयम ऩय गत म भक र न क मट कय यह श ल ऩ क क षक षप त इ नतह, म हद आ श मक ह त अरग रग ए 9 उन ग र अथ श क षक क क षक षप त ब म य ष जन इ फ ध भ प र यण /प र श क षण प र प त ककम क क र अन ब तक क ष णणक/ क नर म ग मत, म हद क ई ह श ल ऩ भ क र फ ध ड ग र, म हद क ई ह 12 श ल ऩ भ शभर ऩ यम ऩ रयक तकन क ऩय भह यत
8 13 नम ड ज इन क शभर कयन क क षभत 14 श द हस त श ल ऩ द य श ल ऩ क व क, ध य औय उ क तकन क क ओय म गद न क क षक षप त ब म य 15 श ल ऩ द य ननशभटत अ नत व श ट क म /भद क ब म य क म इनभ कक क ग रह रम, भ हदय, कर भ क षक, म भ ननत ऩ य ण म द य य द गम ह क म द क भथटन भ क ई दस त ज ह? 16 श द हस त श ल ऩ न ऩयम ऩय क आग फढ न क शरए कक प रश क षण स थ न भ प रश क षण हदम ह ककतन म ऩ ढ क श ष ल ऩम क प रश क षक षत ककम गम ह 17 आ दक श द हस तश ल ऩ क ऩ यस क त ऩ यस क य अ थ टत क रभ क ऩ यस क य ऩ यस क य प र प त य टर म ऩ यस क य /य ज म ऩ यस क य /श र टठत प रभ ण -ऩत र क न भ कयन क र ट क ब म य 18 ऩरय य भ कक अन द म ऩ यस क य व ज त, महद क ई ह, क ब म य, ऐ ऩ यस क य व ज त क थ अऩन फ ध फत ए य ज म ऩ यस क य र ट द टए, य टर म ऩ यस क य र ट द टए म य टर म श र टठत प रभ ण-ऩत र र ट द टए 19 उन भ ख म प रद टन क ब म य ष ज भ श द हस तश ल ऩ न अऩन क र द टन क शरए अथ अऩन क नतम प रदश टत कयन क शरए ब ग शरम ह 20 श द हस तश ल ऩ क औ तन प र नतभ ह ककतन कभ ई ह 21 क म इनक क म क क ई प रक न/दस त ज ह 22 श ल ऩ औय श ल ऩग र ऩ यस क य प रव ष ट उत ऩ द क ब म य ष ज भ उत ऩ द क प र श ग क य व शबन द न यण क कभ कभ 8 x10 आक र क फ ट ग र फ शभर ह महद ब ह त उत ऩ द प र कक रम क ड म ग र प प रस त त कय कम स कम त न नम न प रस त त ककए ज ए जजसम क यम ककए ज र श ल प क प रववजटटय
9 23 प रस त त ककए गए श ल ऩ नभ न /नभ न क भ ल म 24 क म नभ न श द हस तश ल ऩ क ह महद नह त म कक क ह? 25 हस तश ल ऩ भ प रश द स थ न / व मष क त द य श द हस तश ल ऩ क श ल ऩ भ क षभत औय श ल ऩ क व क ह त उनक म गद न क फ ध भ प रभ ण (महद क ई ह ) 26 म भ न, रयक क ब म य महद क ई ह 27 श ल ऩ फ ध क ई अन द म ब म य ज अन द म क रभ भ नह हदम गम ह 28 श ल ऩ ग र ऩ यस क य ह त प रव ष ट क ननभ टण भ रग क र अ धध 29 श ल ऩ ग र क शरए फन ई गई प रव ष ट /उत ऩ द क -ऩत र फ ध भ क षक षप त न (मह हह द तथ अ ग र ज भ एक अरग भ आ दक क हस त क षय हहत अ श म हदम ज ए) 30 क म प रव ष ट ऩ णट र ऩ क र आ दक द य फन ई गई ह म अन द म क य गय क ह मत ब र गई ह 31 महद ह, त इ फ ध भ प र प त ह मत क ब म य द 32 महद यक य, प रस त त भद क य दन ह, त क म आऩ उ फ ग? 33 महद ह,त बफक र भ ल म अ ककत कय 34 नभ न क न क न क भ भर भ द नह कयन फ ध हरपन भ न ट ) 1 : आ दक क बफन क ई न ह हदए अध य बय गए प भ क यद कय हदम ज एग 2) प रथभ श र ण भष जस र क हरपन भ क अर, आ दक द य प रस त त अन द म ब दस त ज क कभ कभ य जऩबत रत अधधक य द य अन प रभ णणत कय म ज ए 3) क ऩम प रत म क दस त ज औय आ दन क थ रग न क र ऩ टठ क उल र कय
10 प रम ण-पत र : इ आ दन क थ प रस त त प रव ष ट / प रव ष ट म क आ दक श द हस तश ल ऩ ऩ त र / ऩ त र /ऩत न श र द य स त भ फन म / ननशभटत ककम गम ह औय इ आ म क स म ऩ ऩ ऩय ऩय प रथम श र ण म जजस र ट द व र व धध त हस त क षरयत ऩथ ऩत र रग न ह (श द हस तश ल ऩ क हस त क षय) प न नम फय ए क क थ भ फ इर नम फय आ दक औय रग न दस त ज भ हदए गए ब म य क ज कय त म वऩत ककम गम ह औय भ प रभ णणत कयत / कयत ह कक मह प रव ष ट स म श ल ऩक य/ फ नकय द य फन ई गम ह औय म एक स तव क श द हस तश ल ऩ ह ननद क उऩननद क / आई / ह मक ननद क फ धधत ह0 व 0 ए व 0 क 0 उऩननद क/ ह मक ननद क क स त नत अन प रभ णणत कयन र अधधक य क न भ ए हस त क षय ऩ य ऩत क थ यफड स म ऩ हहत हस त क षय अन प रभ णणत कयन र अधधक य क न भ ए हस त क षय ऩ य ऩत क थ यफड स म ऩ हहत हस त क षय ( इ य ज म स तय म मन शभनत भ म जक द य क र उन आ दक क फ ध भ बय ज ए ष जनक मन अगर स तय क शभनत अथ टत भ ख म रम स तय क शभनत ह त ककम गम ह ) प रभ णणत ककम ज त ह कक आ दक क स तव कत, आ दन औय अन द म फद दस त ज भ, क य गय क क र स तय क शभर कयत ह ए हदए गए उनक व यण क ऩ न: अशबननष श त/ त म वऩत ककम गम ह र ज य स तर य चयन सशमतत क स य जक क स त क षर न म एव प र पत रबड स ट म प सह त
11 पथ पत र श ल पक र द व र स ट प प पर पर र टर य प रस क र 2015 प रततय गगत क शऱए अपन प रववजटट प रस त त करन त भ श र /श र भत / श र... जन द भनतधथ क अन य आम... ऩ त र/ऩत न /ऩ त र श र... नन... त मननटठ घ र ण कयत /कयत ह औय न द त /द त ह कक वर म 2015 क शऱए श ल प ग र प रस क र प रततय गगत क शरए भ य द य प रस त त मह भद... (भद क न भ) श ल ऩ... ऩ णटतम भ य द य त म य क गई ह औय व गत... र भ......तक... (श ल ऩ क न भ) ऩय क भ कय यह /यह ह भ झ र ट... भ हस तश ल ऩ क क ष त र भ य ज म ऩ यस क य र ट... भ य टर म ऩ यस क य औय हस तश ल ऩ क क ष त र भ र ट... भ य टर म श र टठत प रभ णऩत र प रद न ककम गम ह भ मह ब न द त /द त ह कक महद उऩम क त कथन अ त म ऩ म ज त ह त भ य व र द क षभ प र धधक य द य क गम भ ध त क य ई क शरए भ त म य यह ग /यह ग भ मह ब न द त /द त ह कक अऩन ज ण भ औय उत तयद नमत ऩय श ल प ग र प रस क र 2015 क शरए अऩन प रव ष ट प रस त त कय यह /यह ह औय इ द य न, महद इ भद क र न र ज न भ म कक अप रत म श त क यण इ भद क क ई न क न, क षनत म य आहद ह त ह त उ क ष ज म भ द य भ य ह ग औय इ फ ध भ क षनतऩ नतट ब यत यक य, व क आम क त (हस तश ल ऩ) क म टरम, स त र भ त र रम, य ज म यक य, आई आहद द य नह द ज एग आ दक श द हस तश ल ऩ क ऩ य न भ... ऩत... त य हहत हस त क षय... ( प रथभ श र ण भष जस र द य अन प रभ णणत ककम ज ए)
12 श ल प ग र प रस क र-2015 क शऱए ज वन व त त भ जन त प र फ म म 1. न भ (हहन द द अ ग र ज द न भ ) : 2. वऩत /ऩनत/ऩत न क न भ (हहन द द अ ग र ज द न भ ) : 3. जन द भस थ न : 4. जन द भनतधथ : 5. ऩत वऩन क हहत : 6. प र प त श क ष /प रश क षण : 7. श ल ऩ ऩय ऩय : 8. क र म गद न (जफ श ल ऩ ऩय क मट कय यह ह ) : 9. ब यत म/व द प रद टननम भ हब धगत : 10. क ई अन द म व र बफन द द : 11. र प न/भ फ इर न फय,ईभ र आई (महद क ई ह ) : हटप पण 1. प रस त त क गई मद य श ल प क स क षक षप त प टठभ शम स ऱग न कर जजसम श ल प क इतत स तथ उसक तनम मण क प रक य भ द गई 2. आव दक श ल प क स क षक षप त ज वन-व त त ज (ट इप) एक प ज़ स ज य द न 3. ज भ य तनहदमटट ककय गय कक य प र फ म म ह न द एव अ ग र ज म भर ज ए व द न भ र ओ क प रय ग क रण अतनव यम `````````````````````````````` क र गर क स त क षर
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