GOVERNMENT OF ANDHRA PRADESH DIRECTORATE OF INDUSTRIES APPLICATION FORM FOR PERMANENT REGISTRATION AS SMALL SCALE INDUSTRIES (TO BE FILLED IN DUPLICATE) INSTRUCTIONS: 1. Write/Type in block (capital)letters. 2. Fill up whichever is applicable. 3. Use English alphabets/ Arabic numbers while up block (to help computerisation).Leave one blank after each word. 4. While filling the form, use the following procedure: i) Name of unit e.g KAMAL Enterprises/G.K. Enterprises K A M A L E N T E R P R I S E S G K E N T E R P R I S E S ii) Pin CODE : e.g 110041 iii) Date e.g. 23RD JUNE 1959 iv) quantify (Kg) e.g 90 kg v) Amount (Rs in thousands ) e.g Rs.5000/ vi) Fill up appropriate codes in the blocks wherever applicable. Example1: Yes-1, No-2, Na-3, if NA fill -up-3 Example 2: Category: SSI-1, Anc-2, Tiny-3 SSSBE-4, EOU-5 if Tiny fill up-3 5. Block/Boxes makred(*) are to be filled by office. 6. Applicant should sign all copies. Abbreviations used: SSI : Small Scale Industries. ANC : Ancillary Industrial Undertaking . SSSBE : Small Scale Service and Business Enterprises. TINY : Tiny Enterprise. EOU : Export Oriented Unit. NA : Not applicable. FORM 1. Name of Unit/ Applicant 2. Address for communication: Tel: PIN 3. Category of Unit: SSI-1, ANC-2, SSSBE-3, TINY-4, EOU-5, 4. Location. Place / Town Tehsil / Taluk District State 5. Type of organisation. Proprietory-1 Partnership-2, Privet Company-3, Co operative-4, Others-5, 6. Nature of activity Manufacturing /Assembly Processing Job Work Repairing /Servicing Note: For any combination of activities, add the respective codes to get the required code. 7. Main items of Manufacture / activities. i) Name: Code: ii) Name : . Code: iii) Name: Code: iv) Name: Code: v) Name: Code : 8. Investment if Fixed Assets (Rs. in '000) i) Land ii) Building iii) Plant and Machinery iv) Other fixed assets Total 9. Investment in plant & Machinery (Original Value Rs. in '000) Note: Should exclude items whose value is not taken account while computing the investment, Please enclose profile in case value of investment in plant & machinery exceeds Rs. 40 lacs. 10. Power land H..P. (H.P.= 0.795 K.W.) 11. Employment I) Managerial & Office Staff ii) Supervisory and Workers 12. Date of commencement of production ( Estimated) Signature of Applicant ( Authorised Person) Date: Name of Proprietor/Partner/ Managing Director FOR OFFICE USE ONLY Application No NIC Code Block Code Disctrict Code State Code Location of Unit (Confirming-1, Non Confirming -2) Whether the items of manufacture/activity require an industrial licence. (no industrial licence is required for items listed in Schedule -ii of the licencing notification dated 25.7.1991 if the unit employs less then 50/100 workers with/without power). GOVERNMENT OF ANDHRA PRADESH DEPARTMENT OF INDUSTRIES PERMANENT REGISTRATION CERTIFICATE The unit is permanently registered as a SSI/SSSBE unit for the manufacture of items/activities as stated in the application form and briefly noted below: Name & Address of the unit: Factory location : Item of manufacture / activity (S.No.11 & Appendix -A) 1. 2. 3. 4. Investment in plant and Machinery (S. No. 13 & Appendix - B) Rs in '000 Permanent Registration No: Date of Issue: Category of unit (S.No. 6) Date of Commencement of Production: FOR TINY ENTERPRISES The unit is a tiny enterprise and its status as " tiny enterprise" is valid upto------------------- Validity is extended upto --------------------------- validity is extended upto ---------------------------Date : Signature Name & Designation of Registering Authority The enclosed application form is a part of the certificate of registration. The certificate is valid for the items of manufacture / activity noted at S. No. 11 and appendix A and is also valid for any other item/activity undertaken by the unit. Conferment of the status as a tiny enterprise to be validated / renewed every five years as per procedure prescribed. The Certificate is subject to the affidavit furnished by the applicant in respect of the application for registration. The certificate is subject to any or all the conditions that may be imposed by the Registering Authority. If at any time it is found that the declaration/ affidavit furnished by the applicant is nit true or in the event of violation of any of the conditions imposed by the registering authority or if the investment exceeds the prescribed limit, the registration certificate is liable to be cancelled / quashed without anyprior notice. This certificate does not confer or accrue any right to the applicant and cannot be treated as proof in respect of any statutory requirement or condition that may exist under any law for the time being in force. The onus of satisfying and fulfilling such requirements or conditions rests squarely in the applicant/unit. Additions/deletions in the list of plant and Machinery and the revised investment value thereof and/or any changes in the constitution or location of the unit should be made in the additional sheets appended to the certificate on the request of the applicant. CERTIFICATE OF REGISTRATION ADDITIONAL SHEET-1 Registration No. Date of issue. Addition/ deletion in plant & Machinery Original Value S, NO Name of Machinery Added/deleted (Rs. in '000) 1 2 3 4 5 (Rs. in '000) Revised value of investment in plant & Machinery(S. No. 14) Change in location: (S. No. 7) Change in constitution / type of organisation: (S. No. 9) Signature Date : Signature Name & Designation of Registering Authority Appendix-A For any combination add the respective codes (Value in rs'000) Sl No.(1) Product & by-products manufactured /assembled & services sold(2) Product code(3) Unit of Quantity(4) Unit Code(5) Annual Capacity(6) Quantity Value (7) 1 2 3 4 5 6 7 01 Manufacturing/assembly 02 03 04 05 Other prod & by-prd(comb) 06 Total (1 to 5) x x x x x 07 Processing 08 09 10 11 Others (Combined) x x x 12 Job Work x x x 13 Servicing x x x 14 Repairing x x x 15 Total (12 to 14) x x x x 16 Grand Total (6+ 11+ 15) x x x x APPENDIX - B Details of Plant and Machinery Name of the Imported-1 (Original Value) l. NO. Machinery CostIndigenous-2 Rs in '000 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
