Instructions for filling up Application form for Obtaining provision Registration Certificate (To be filled in Duplicate) Instruction: 1. Write/type in block (Capital) letters: 2. Fill up whichever is applicable. 3. Use English alphabets/Assamese while filling up blocks (to help computerisation). Leave on blank after each word. 4. While filling the form, use the following procedure: 5. i. Name of unit: e.g. KAMAL ENTERPRISES K A M A L E N T E R P R I S E S ii. Pin Code e.g. 781021 iii. Date, e.g. 1st January'04. iv. Quantity (Kg.) v. Amount (Rs. in thousand) e.g. 5,000/ vi. Fill up appropriate codes in the blocks wherever applicable Example 1: Yes-2, No-2, if not applicable fill up-3 Example-2: Category: SSI-1, ANC-2, Tiny-3, SSSBE-4, And EOU-5, if tiny fill up 6. Block Boxes (*) are to be filled by office. 7. Applicant should sign all copies. GOVERNMENT OF ASSAM DIRECTORATE OF INDUSTRIES & COMMERCE ASSAM BAMUNIMAIDAN GUWAHATI-21 Application form for provisional Registration as Small Scale Industries (To be filled in Duplicate) 1. Name of unit/Application 2. Address for Communication 3. Category of Unit SSI-1/ANC-2/SSSBE-3/Tiny-4/EOU-5 4. Location Village/ Town Post Office District State 5. Type of Organisation Proprietory-1/Partnership-2/ Private-3/ Co-Operative-4/ Others-5 6. Nature of Activity Manufacturing/ Assembling-01/ processing-02/ Job Work-04/ Repairing/Servicing-08 7. Main items of manufacture/Activities (1)Name Code (ii)Name Code (iii)Name Code (iv)Name Code (v)Name 8. Investment in fixed Assets (Rs. in 000). (i)Land (ii)Building (iii)Plant & Machinery (iv)Other fixed Assets Total 9. Investment in plant and Machinery (Original value Rs.in 000) Note. Should exclude items whose value is not taken into account while computing the investment please enclose project profile in case value exceeds Rs.40 lakhs. 10. Power Load H.P. (1 H.P=0.795 kw) K.W. 11. Employment (a)Managerial & Office Staff (b)Supervisory and workers 12. Date of Commencement of Production (Estimated) Signature of Applicant (Authorised Person) Name of Proprietor/Partner/Managing Director FOR OFFICE USE ONLY Application No. NIC Code Block Code District Code State Code Location of Unit Conforming-1/Non Conforming-2 Whether the items of manufacture/Activity require an Industrial Licence, If yes-1, If No-2 No Industrial Licence is required for items listed in Schedule-2 of Licensing notification dated 25-7-91 if the unit employees less than 50/100 workers with without power.
