Application for the Interest on Delayed Payments to Small Scale and Ancillary Industrial Undertakings (See Rule 7) For use in Council's Office Data of Filing Data of receipt by post or Registration No. Signature of the Authorised Officer. In the Industry Facilitation Council (Name of the Place) BETWEEN AB And CD APPICANT RESPONDENT Delete whichever is not applicable Details of Application : 1. Particulars of the applicant (i) Name of the applicant : (ii) Address of Registered Office : (iii) Address for service of all notices : 2. Particulars of the respondent (i) Name of the respondent : (ii) Office address of the respondent : (iii) Address for service of all notices : 3. Jurisdiction of the Council : The applicant declares that the subject matter of the interest on delayed payments due falls within the jurisdiction of the Council. 4. Fact of the case : The facts of the case are given below (Give her a concise statement of facts in a chronological order , each paragraph containing as nearly as possible as separate issue, fact or otherwise). 5. Relief (s) sought. In view of the facts mentioned in para 5 above, the applicant prays for the following relief(s):[Specify below the relief(s) sought explaining the ground for relief (s) and the legal provisions (if any) relied upon] 6. Interim order, if prayed for ; Pending final decision on the application, the applicant seeks issue of the following interim order : (Give here the nature of the interim order prayed for with reasons). 7. Matter not pending with any other Court, etc. The applicant further declares that the matter regarding which this application has been made is not pending before any Court of law or any other authority or any other Bench of the Council. 8. Particular of Bank Draft/Postal Order in respect of the Particulars of Bank Application fee : 1. Name of the Bank on which drawn : 2. Demand Draft No. : OR 1. Number of India Postal Order(s) : 2. Name of the issuing Post Office : 3. Date of issue of Postal Order(s) : 4. Post office at which payable : 9. Details of Index : An index in duplicate containing the details of the documents to be relied upon is enclosed. 10. List of enclosures : Verification : I, _________________________________ ( Name in full and block letters ) son/daughter/wife of Shri _________________ being the ______________ (designation) Of ___________ to 10 are true to my personal knowledge and belief and that I have not suppressed any material facts. Place : Date :
