GOA INDUSTRIAL DEVELOPMENT CORPORATION Plot No. 13A -2, EDC Complex, Patto Plaza, Panaji - Goa 40;3 001 APPLICATION FORM FOR TRANSFER OF SHED/PLOT Name of Estate__________________________________________________________________________ ________________________________________________________________________________________ Part - I (To be filled in by the transferor) Allottee: 1. Name and address of the allottee: 2. Plot No./ Shed No. allotted Area of Plot in Sq. Mts. 3. Date of allotment - date of agreement / Dates lease-deed, conveyance deed, date of taking over possession a) Allotment b) Agreement c) Possession d) LD / CD . ection 4Date of obtaining water connfor const. use (if it is a plot) ermanent water 5. Date of obtaining p connection. 6. Date of obtaining power connection for industrial use. . 7Date of commencing production. (enclose copy of Permanent Registration) Items being manufactured. 8. " Contd.........2 -2- 9. For verification of utilisation of plot/shed following documents may please be enclosed. a) Power supply bills for last three months. raised by power supplying agency b) Copy of challans paid to Sales Tax Dept. for last three months. . c) Water supply bills for the last three months raised by Water Supplying Agency. d) Details of exise duty paid for items manufactured in the plot/shed allotted. e) Information about the workers employed. f) In case of plot built up area for already plans have been approved by the competent authority including letter No. and dt. (in case of competent authority other than Goa-IDC, a certified true copy of plan should be attached.) g) Details of actual construction carried out as per approved plans....................sq. mts. i) Factory ii) Storage iii) Any other building________________ Total Sq. mts. Whether it will be possible to obtain independent plot on compulsory surrender/when the built up area is less than 1/5th of plot area. . The area________________to be obtained on surrender. The dimension Length_______________mtr. Width________________mtr. Contd........3 -3- 10. a) In Case of partnership Finn all the partners have to sign this application. b) In case of Private Limited Company /Limited Company. certified copy of resolution passed by the Company should be enclosed. 11. Details of any other allotment held. i.e. Housing quarters____________________no. Housing plot_______________________Sq. Mts. Godowns__________________________no. Any other property no.________________ (Signature of the Allottee with stamp) ____________________________________________________________________________ Part - II (To be filled in by the transferee) 1. Name of Individual/Firm /Company : For which plot is applied for 2. Address: : a) Registered Office : Tel No. : e-mail : b) Local Office : Tel. No. : 3. Constitution : Proprietory / Partnership /Private or Public Limited. Company (enclose a copy of Partnership Deed or Memorandum and Articles of Association alongwith Registration Certificate / certificate of Incorporation Respectively. ) 4. Date of Registration / Establishment of Firm / Company Contd.........4 -4- 5. In the case of Proprietory / Partnership/Private or Public Limited Company, please State :- Name(s) of Director/ Partners/Proprietor firm Shares in Residental address with Phone No. Qualification Buisness background 6. Proposed location of Factory : 7. Area of plot required: 8. In case of plot. state: a) Area of building to be constructed. b) Area to be reserved for further expansion. 9. a) Provisional S.S,I. Registration / DGTD Registration /Letter of Intent, number (enclose Photosate copy) b) Name and Address of your Bankers: c) Copy of Provisional Certificates issued by the Office of the Textile Commissioner. (if applicable enclose copy) 10. Attach latest Income Tax Clearance Certificate or Exemption Certificate. Whichever applicable. 11. Please give the particulars of firms/industrial cities wherein proprietor/partners/ directors of this unit are having insterest associating Name(s) of Director/ Partners /Proprietor Name and Address of business firm activities carried out Relationship Share in Business Contd.....5 -5- 12. Nature of Industry . 12 A. Name of Products: a) Is it an ancillary unit (if so enclose copy of approval) 13. Give details about products to be manufactured: Items to be Manufactured Annual Qty. Production Value Use of the Product 14. Water requirement per day (in ltrs.) : 15. Total power required (give details) in KVA/ HP : 16. List of machinery alongwith their power requirement in H. P. (enclose sheet if required) a) b) c) d) e) f) 17. In case the machinery is old & being shifted from one State to another (copy of the consent letter from that Govt. is to be submitted). 18. Submit complete project profile and state whether it relates to . a) New Project b) Modernization /Expansion/ Renovation/Diversification. 19. In case of chemical industry. please state: a) Raw material used in the process b) Type of effluent. if any c) Arrangement for treatment and disposal . d) Attach flow chart and process parameters~ Contd.......6 -6- 20. a) Whether you have obtained NOC from Environmental Pollution Cell (Directorate of health Services) (enclose copy) b) NOC from Goa State Pollution Control Board (enclose copy) . 21. Raw Material (Annual requirement) A) INDIGENOUS: i) Type of raw material ii) Volume cost (annually) iii) Source of Supply B) IMPORTED: i) Type of raw material ii) Volume and cost (annually). iii) Source of supply. . (State Country of origin & State of import is controlled /free) 22. Number of persons to be: Employed Qualification Male/ Female Experiences Goan/Non Goan required a) Managerial b) Skilled c) Semi~skilled d) un-skilled d) Other-staff 23. Please state, if you have entered into a foreign: collaboration, If so, please enclose copy of approval. 24. Submit details of collaboration agreements if : any netered into by the unit 25. Uses of bye-products, if any Contd..........7 -7- 26. Project Cost Cost (Rs. in lakhs) Land (area x rate) Rs. Factory building Rs. Plant & Machinery a) Indigenous Rs. b) Imported Rs. Transportation Rs. Power supply & cabling etc. Rs. Erection charges Rs. Furniture, fixtures & office equipments Rs. Preliminary & pre-operative expenses Rs. Provision for contingencies Rs. Margin for working capital Rs. ______________________ TOTAL PROJECT COST Rs. ______________________ 27. Means of Finance Promoters Capital Rs. Unsecured loans and deposits Rs. Terms loan from Financial Institution/Banks Rs. __________________________ TOTAL Rs. __________________________ Contd...........8 -8- 28. Attach term loan sanction letter from : Financial Institutional/Banks. 29. Arrangements made for working : capital requirements (attach copy of the sanction letter) 30. Whether machinery has been booked : (attach documents). The information provided above is correct to the best of my knowledge and belief. Signature of Transferree / Proprietor /___________________________ Partner / _________________________ Director with Seal of the Company__________________________ WITNESSES: (Name and full Address) 1_______________________________ 2_____________________________________
