~ CHANDIGARH ADMINISTRATION DEPARTMENT OF INDUSTRIFS 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 filling up blocks (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 } (ii) Pin Code: e.g. 110041. (Hi) Date: e.g. 23rd June 1959. (iv) Quantity (Kg)e.g.90Kg. (v) Amount (Rs.inthousands) e.g.Rs.5000/- ~ (vi) Fill up appropriate codes in the blocks wherever applicable. Example 1: Yes-I, No-2, NA-3, If NA fill up-3 ~ 1 Example 2 : Category: SSI-1, Anc-2, Tiny-3, SSSBE-4, EOU-S, ~ If Tiny fill up-3 ~ 5. Block/boxes marked (") are to be filled by office. 6. I Applicant should sign all copies. Abbreviations used: 5SI : Small Scale Industries, ANC: Ancillary Industrial Undertaking, SSSBE: Small Scalc S(~rvice and Busim'ss Enterprisc, TINY: Tiny Enterprise, EOU: Export Oriented Unit, NA: Not Applicable. I i \ =~K FORM 1. Name of Unitj Applicant: 2. Address for communication: Tel: Pin Code ITJJTIIJ [IT[[[] 3. Category of Unit: SSI-1, ANC-2, SSSBE-3, TINY-4, EOU-5. 4. Location: Place/Town Tchsil/Taluk District State 5. Type of organisation: " Proprietory -1,Partnership -2,Pvt.company -3, Co-operative -4, Others -5. "6. Nature of activity. Manufacturingj Assembly (01) Processing (02) Job work (04) RepairingjServicing (08) I I .,.r I J. D D - J CD ! Note: For any combination of activities, add the respective code to get the required code. 2 J r I I r "\.. 7. Main items of manufacture/activities: (i) Nc\me : Cod(. : * I I (ii) Name: I I Code:* I I. (iii) Name: I Code:* (iv) Name: Code: * (v) Name: Code: * 8. Investment in Hxed assets (Rs. in '000) (i) (ii) (Hi) (iv) Land Building Plant and Machinery 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 - ITIIIJ ITIIIJ ITIIIJ []]ll] []]ll] ITIIIJ the investment. Please endose project profile in case value of investment in Plant and Machinery exceeds Rs. 40 lacs. 10. Power Load H.P. ".. : ITIJ KW. (1 H.P. = 0.795 KW.) ITIJ 11. OJ Employment: (i) Managerial and office staff ITIJ (ii) Supervisory and workers 3 J' 12. Date of commencement of production (estimated) ITIIID Date: ITIIID Signature of Applicant (Authorised Person) Name of proprietor/partner/managing director FOR OFFICE USE ONLY I 'I Application No.DIm NTCCode DIIJ I, Block Code District Code State Code IT] IT] IT] Location of Unit (Conforming-1, Non-conforming-2) - D ~ Whether the items of manu factu re/ activity require an industrial licence. Yes-1, No-2 (No industrial licence is rL'tluired for items listed in Schedule JI of the licensing notification dated 25-7-199"1if the unit employs less than 50/100 workers with/without power). 4 ~"-~ PROVISIONAL REGISTRATION The application is accepted for Provisional Registration as a SSI!SSSBE Unit for the manufacture of items/ activities as stated in the application form. Provisional Registration No. : Date of issue: ITllIIJ Category of unit (5. No.3) : (Signature) General Manager, District Industries Centre, U.T., Chandigarh. 1. The endorsed application form is a part of 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 setup the unit within the validity period, the applicant! unit has the option to apply afresh for provisional registration using standard procedure. I 5. \ The provisional registration is given to enable the unit to obtain all facilities! clearance etc. required in the pre-production stage. , I 6. The provisional registration is subject to any or all conditions that may be imposed by the Registering Authority. I ~ ..; 312jD.I.C. (UT) -Hem 1-Typeset & Printed at Govt. Press,U.T., Chd. 5
