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