Application Form For Financial Assistance for Food Fortification A. Promoter: 1. Name & Address (Telephone/Fax) 2. Background/Experience 3. Financial Status (Bankers name, if any) B. Project Description: 1. Name of Project 2. Location/Area 3. Source of getting the premix (name of the company) 4. Quantity of premix required (monthly/yearly basis) 5. Quantity of wheat flour targeted for fortification 6. Products/by-products (their specifications & use) 7. Process/Technology (with flow chart) 8. Installed Capacity of unit (per day/per year) 9. Date of registration with registering authority(with proof) 10. Laboratory testing facilities for fortified atta C. Project Cost: (Existing unit) 1. Capital Investment (Fixed Capital) (a) Land Area Cost Ownership proof (b) Technical Civil works 2. Plant & Machinery (Capacity/Specification/Cost) 3. Installation of plant & machinery 4. Imported Machines (if any) (Capacity/Specification/Cost) 5. Pre-operative expenses 6. Working Capital 7. Raw Material/Packaging (Source/Quantity/Cost) 8. Details of employment generated (Direct/Indirect). Proposed project details 9. Details Of Plant & Machinery Required For Fortification, which includes specification of item/make/cost/capacity with copy of pro-forma invoice/bills. 10. Appraisal report by Bank/Financial Institution containing details of proposed project and financial parameters. 11. Project cost of the proposed project, which includes technical civil works and plant & machinery as well as premix. 12. Certificate from concerned authorities regarding confirming to quality standards. D. Finance: 1. Means of Financing for fortification activity (a) Equity (Promoter/Foreign/Other) (b) Loan (c) Fund requirement from Ministry (MFPI) (d) Other sources, if any. D. Implementation Schedule: Items of work Date of implementation Place: Date: Signature of Applicant 75 76
