Registration Form Registration Form Farmer Name * First Last Father/Husband Name * First Last Gender * Male Female other/custom Age * Village * Tehsil/Taluka * District * State * Mobile no. * E-mail * Adhaar No. (optional) * Lands Khata No./Khasra No * Total Area in Acre Land * Own Lease Farming Area in acre * Cropping Pattern Single Mixed Major Crops for Livelihood like- Makka, Bajara etc. Crops under contract farming with Vinayak Herbal * Hint – amla, aloevera, Giloi etc…. Crops Collected for Vinayak Herbal Medicinal Herbs & Qty Soil Type * Water Source * Farmer is certified Organic * Yes No if Yes, Total area ICS Operating Agency In Which Year Farmer Started Organic Farming Name of Certification Agency Certification Status Suggestion (if any) Image Upload Select Image