Application for ALLOTMENT OF LAND to IT Industries Paste Passport-size photograph of MD/CEO To The Secretary to Government Information Technology and Communications Department Government of Andhra Pradesh D Block, 3rd Floor, AP Secretariat Hyderabad-500022 Check eligibility criteria for allotment of land as specified in ICT Policy 2005-2010 issued vide G.O.Ms. No: 11, dated:21-03-2005 before applying. All columns need to be filled to avoid rejection I. Details of IT Company: 1. Name of the IT Company: 2. Name of the Managing Director/CEO: 3. Income-tax PAN No of Co. 4. Name(s) of the Director(s): i.. ii.. iii.. iv.. II. Address of Applicant/Co: Address: Contact Person: Email: Mobile: Telephone: -:2:- III. Nature and activities: a. Constitution of the Organisation(Pl. .mark): Proprietary Partnership Pvt., Ltd., Ltd., Co. b. Activity (Pl. .mark): Line of Activity IT IT Enabled Services IT/Electronic Hardware IT Infrastructure Telecom Training Institution Present Proposed IV. Existing Status: c. Date of incorporation of the Company/Firm ........ Enclose Memorandum and Articles of Association d. Investment Made: i) Plant & Machinery: Rs. ............ ii) Land & Buildings: Rs............. iii) Total: Rs. ............ e. Date of commencement of commercial operations: / / f. Performance from the inception of the Company: (Rs. in crores) for eg: 1= 1 crore (Rs 10 Million) Year Export turnover Domestic turnover Total turnover* Provide Annual Reports g. Total number of Employees employed at present: -:3: h. Projections for next 5(FIVE) years: (Rs. in crores) for e.g: 1= 1 crore (Rs 10 Million) Year Investment Turnover Employment Enclose Business/Action Plan of the Company V. Requirement of Land Why is land required? How does it enhance your business? Proposed Activities: Proposed Number of Employees: Proposed Investment: Extent of land required : Location/Place of land required: Proposed Built up area (in sq. ft.): Proposed Start Date: Proposed Completion Date: Source of funding : Company should be in the proposed line of activity for a period of five years from the date of completion of the building for not attracting penal interests and revoking of the land. VI Any other relevant information/comments/remarks: ..................................... ..................................... ..................................... ..................................... ...................................... DECLARATION I hereby declare that the particulars/information as given in the application are correct to the best of my knowledge and belief. Place: Date: Signature: Name of the Authorized signatory: Designation: Mobile No:
