NO. FORM - 1 PART - C1 ALLOTMENT OF LAND/SHED IN IE/IDA BY APIIC Fee Structure Amount to be paid : Non Refundable Process Fee of Rs.250/- and EMD @10% of sale consideration Mode of payment : D.D in favour of APIIC Check Slip 1. Part C1 of Form-1 2 copies + 1 copy to nodal agency 2.Prov.SSI/IEM/LOI/EOU Registration Certificate 3.Partnership deed/Memorandum of Articles 4.Financial arrangements, if any 5.Total area required in acres 6.Plot/Shed No. Location 7.Details of fee paid: D.D.No Amount Date SIGNATURE OF THE APPLICANT NO FORM - 1 PART C 1 ANDHRA PRADESH INDUSTRIAL INFRASTRUCTURE CORPORATION LTD. HYDERABAD APPLICATION FOR INDUSTRIAL PLOT(S)/SHEDS(S) I/We here apply for registering my/our requirements of land or ready built shed(s) for industrial purpose in APIIC industrial Area ____________(Name of Area) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I/We hereby furnish the necessary information in respect of my/our industry which is proposed to be newly setting up / re-location (shifting/Expansion/Diversification as under . 1. Personal Details 1.1 Name(s)and full address of the applicant(s) In BLOCK LETTERS for whom allotment is Sought for with Tel., Fax, E-mail No. 1.2 Permanent Address of the Applicant(s) in BLOCK LETTERS with Tel., Fax., E-mail No. 1.3 (a) Constitution / status of the unit i) Properietory concern ( ) please enclose Deed /Certificate of ii) Partnership firm ( ) partnership Deed /Certificate of iii) Private\public Ltd.Co. ( ) Incorporation & Articles of iv) Co-op. Society ( ) Memorandam,Articles of v) Statutory Body ( ) Association/Certfication of vi) State/Union Govt. Dept ( ) Registrations & Address(s) (b) Give the name(s)of the proprietor / partner / Directors 1.4 Whether the applicant(s) belongs to SC( ) ST ( ) reserved Category is yes, Please tick Ex.Ser.men ( ) (v)mark and enclose the necessary Technocrat ( ) certificate ( in the case of proprietory / Woman ( ) Partnership firm only) Resigned from service of PSU ( ) 1.5 Please furnish the details of the Proprieties which the applicant holds as a owner /having interest with location details like village Revenue Mandal, Local body, District and its approximate market value 1.6 (a) Has the applicant in possession of i) Plot No.on ________________ premises in part or whole in his own, Name of Indl. Area sister, subsidiary or associated concerns ii) Shed (Plot, Shed ,Shop, House etc) in any of the iii) Shop industrial areas of APIIC, if so please give iv) House the details of the same: v) Others vi) Status Allottee/(sub)lesses in name & style of M/s________________ -2- (b) Details of the dues payble to APIIC onany : account including water charges, Property tax etc. 2. Project Details 2.1. Please indicate the nature of project : Export oriented ( ) Import substitute ( ) Other ( ) 2.2 Please indicate category of your : Engg ( ) Chemical ( ) Electronic ( ) Textile ( ) Food ( ) Plastic ( ) Leather ( ) Rubber ( ) Pharma ( ) Ceramic ( ) Service ( ) Other ( ) 2.3 Please specify the line of manufacture : 2.4 Product(s) proposed : a) to be manufactured b) c) 2.5 Name of raw materials required : for manufacture of the above products 2.6 Proposed installed capacity : (Quantity and value) 2.7 Power requirement of the : ______________________________ Project in KW Ph-I Ph-II Ph-III 0-5years 5-10years 10-15years 2.8 Proposed investment in : Plant & Machinery (in Rs.) 2.9 Proposed investment in building : Construction (in Rs.) 2.10 Proposed Employment : a) Supervisory b) Skilled c) Unskilled d) Total 2.11. List of Machinery with the HP/KW required i) ii) iii) iv) v) vi) vii) -3- 2.12 The details of financial : arrangements made/proposed to be made ( copies of letter, if any issued by the financial institutions may be enclosed ) 2.13 If the premises now sought for : allotment is for re-location / shifting / Expansion / diversification, please give The relevant details of present location etc 3 Land Requirement in Sq. : ________________________________ Ph -I Ph - II Ph - III 0-5years 5-10years 10-15years 1) For Production (Factory) portion : 2) For office & ancillary buildings : 3) For open space, garden lawn or road : 4) For effluents discharge : 5) For any other purposes : 6) Total Plinth area ground floor : 7) Addl. Floor, if any : 8) i) Period with in which : construction, work will be a) Commenced : b) Completed: ii) Date by which the applicant expects : to start production 4. Water requirement in litres per day 4.1 Industrial : 4.2 Domestic : 4.3 Total : 5. Detail about effluents 5.1 Quantity of effluents/ per day (litres /day) : 5.2 Solid wastes generated (kilograms/day) : 5.3 Disposal system proposed : 5.4 Type of Pollution, if any and treatment : proposed as per the APPCB standards 5.5 Details of foreign collaboration technical : know-how/finances if any envisaged : 5.6 Whether obtained SSI Registration for the District Industries Centre (DIC) or any other license as may be required (copies to be enclosed) -4- 5.7 Amount paid towards : a) Process fee b) EMD c) Total Rs. D.No. Date: Bank Branch 5.8 Any other relevant information : I/We have read the conditions of the allotment of Plots/Shead in the above industrial Areas together with the APPIIC Industrial Areas Allotment Regulations,. 1998. If I/We fail to comply with the conditions stipulated in ht e Provisions Allotment letter issued to me/us, the allotment remains cancelled automatically and the amount paid by me/us towards EMD remains forfeited by the Corporation with out prejudice to all others rights of the Corporation . I/We further state the that particulars given above are true and correct to my/our knowledge, and belief and that no material facts have been concealed or with held. Place: Signature(s) of applicant(s) with the name below in brackets in BLOCK LETTERS Date: List of enclosures: i) ii) iii) iv) v) Status of Applicant(s) as Proprietory concern / Partner of firm of Director of aCompany or Promotor of firmor Company or Society
