APPLICATION FORM FOR ALLOTMENT OF FACTORY SPACE IN THE INDUSTRIAL ESTATES IN ANDAMAN & NICOBAR ISLANDS [This application shall not be considered if it is not accompanied by the requisite Earnest Money Deposit (Rs. 50/- in favour of Accounts Officer, Directorate of Industries, Port Blair) and Rs. 2/- Court Fee stamp affixed to this application] 1. Name of the Applicant (Mention constitution of Firm with names of Partners, as the case may be) : 2. Name of the Firm : a) Present Postal Address in full along with telephone number (for official correspondence) : b) Factory Address in full along with telephone number : 3. Whether Proprietor/ Partners/ Managing Agents/ Board of Directors has any interest in any large scale undertaking any where in India, if so mention their names and their lines of activity along with License Number or Registration Number : 5. Name of Industrial Estate where factory space is required (Also mention the extent of space required, in square meter) : 6. Whether EMD is paid (mention No. & date) : 7. In case of existing Industry: a) Is the unit located in an industrial or non-industrial area : b) What are the difficulties in continuing the industry in the same place. Mention the reason for request of allotment of space in the Industrial Estate : c) What is the nature of your industry and the type of articles produced : d) What is the capital investment (audited Balance Sheet of the firm duly attested by an approved auditor to be enclosed) Land : Rs. Building : Rs. Machinery : Rs. Working Capital : Rs. Total : Rs. e) What is the turnover per year (Rs.) : f) No. of persons employed Local : Non-Local : Total : g) What is space area now occupied (in square meter) : h) Are you contemplating any expansion programme in the near future, if so furnish details of factory space required for such purpose : i) Type of building to be constructed at the allotted space in Industrial Estate (Furnish detailed estimate along with building plan) : j) What are the raw materials now consumed in your existing industry (furnish name, quantity and value in Rs.) : k) List of machineries installed at present : l) List of machineries proposed to be installed : m) Whether your industry is registered (whether Provisional or Permanent) as SSI/ SSSBE, if so, please quote the registration number : n) Indicate the power supply required in HP/ KW (mention whether single phase or three phase) : o) Indicate the total requirement of water per day (in liters) : p) In case the shed/ space required is allotted to you, what shall be the expected date of commencement of production : q) GENERAL REMARKS : 8. In the case of new industry to be started in the Industrial Estate a) What is the type of industry proposed to start : b) What articles do you propose to manufacture : c) What is your experience in the line of proposed activity : d) Have the project report for the proposed activity been prepared (copy of project report to be attached with this application) : e) Has the project been technically found feasible, if so by whom, copy of feasibility certificate to be enclosed : f) Do you have sufficient finance to start the proposed industry (furnish details of the financial arrangement) : g) Have you made any arrangement to procure machinery The machinery proposed to be erected in the unit may be specified in a separate sheet : The machinery ready for erection may also be specified separately : h) What shall be the expected turnover per year from the proposed industry : i) No. of employees you propose to employ Local : Non-local : Total : j) Name of Industrial Estate where factory space is required (Also mention the extent of space required, in square meter) : k) If space is not available in the Estate opted by you, whether you are ready to take the space in other Estate, if so, please indicate the name of Industrial Estate by order of preference : 1) 2) 3) l) Type of building to be constructed at the allotted space in Industrial Estate (Furnish detailed estimate along with building plan) : m) Indicate the power supply required in HP/ KW (mention whether single phase or three phase) : n) Indicate the total requirement of water per day (in liters) : o) Whether your industry is registered (Provisional) as SSI/ SSSBE, if so, please quote the registration number : p) What are the raw materials required for your proposed industry (furnish name, quantity and value in Rs.) : q) What are the arrangements made for procurement of raw materials : r) In case the shed/ space required is allotted to you, what shall be the expected date of commencement of production : s) GENERAL REMARKS : Note: At the time of occupation three months license fee shall have to be paid in advance. I/ we have read the rules laid down regarding the allotment of factory space in the Industrial Estate. I/ we agree to abide by the rules and conditions that has been laid down by the A & N Administration through the Directorate of Industries regarding the space to be allotted in the Industrial Estate. I/ we shall enter into an agreement with A & N Administration through Director of Industries (before taking possession of the shed/ space allotted) and also make an advance deposit equal to 3 (three) months rent, with the Directorate of Industries before taking possession of the shed/ space allotted. Place: Date: Signature of the Applicant CHECK LIST LIST TO BE ACCOMPANIED WITH THE APPLICATION The following are affixed/ enclosed with the application (Please put tick mark against the items which are applicable) Sl. No Particulars Yes No 1 Court fee stamp of Rs. 2/- affixed on the application 2. EMD of Rs. 50/- in favour of Accounts Officer, Directorate of Industries, Port Blair 3. SSI/SSSBE registration certificate (Provisional / Permanent) 4. Project Report of activity for which applied for shed/ space at Industrial Estate 5. Copy of Local certificate/Islander card 6. Category (ST/OBC of A&N Islands/Women groups/Ex-Service Man) Certificate 7. Audited Balance sheet in case of existing unit 8. Proposed building plan with estimate FOR OFFICE USE ONLY 1. Application No: 2. Date of receipt of application: 3. Date of placement before the screening committee: 4. Recommendation of the Screening Committee (in brief): 5. Date of sending proposal to Administration for allotment: 6. Allotment order No. & date (Administration): 7. Allotment letter No. & date (Dte. Of Ind.): 8. Extent of space/ shed allotted with space/ shed No.: 9. Name of the Industrial Estate: 10.Space/ shed handed over on: 11.Agreement executed on: 12.Agreement expires on:
