GOVERNMENT OF ANDHRA PRADESH DIRECTORATE OF INDUSTRIES APPLICATION FORM FOR PROVISIONAL 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 PROVISIONAL REGISTRATION The application is accepted for Provisional Registration as a SSI/SSSBE unit for the manufacture of items activities as stated as stated in the application for and briefly noted below. Name & Address of the Unit: Factory location: Item of manufacture/ activity(S. No. 7) 1. 2. 3. 4. Provisional Registration No: Date of issue: Category of unit(S.No.3) ______________________ SIGNATURE NAME & DESIGNATION OF REGISTERING AUTHORITY Date: 1. The endorsed application form is a part of the certificate of registration. 2. The provisional registration is valid for a period of five years from the date of issue. 3. The provisional registration will automatically lapse at the end of the validity period or the date of commencement of production, whichever is earlier. 4. If an applicant/unit is unable to set up the unit within the validity period, the applicant/unit has the option to apply afresh for provisional registration using standard procedure. 5. The provisional registration is given to enable the unit to obtain all facilities/ clearance etc. required in the preproduction stage. 6. The provisional registration is subject to any or all conditions that may be imposed by the Registering Authority.
