Download Common Application Form for Industrial Unit for Approvals

COMMON APPLICATION FORM (TO BE SUBMITTED BY AN INDUSTRIAL UNIT FOR APPROVALS) FOR 1) Permission of land from District Collector 2) Assessment of land from Industries Commissioner Requirement 3) Land/Plot requirement from Gujarat Industrial Development in Industrial Estate Corporation 4) No Objection from Gujarat Pollution Control Certificate Board 5) Power Requirement from Gujarat Electricity Board 6) Water requirement from Narmada & Water Resources Department 7) Registration for from Industries Commissioner Incentives This common application is to be filed with the Industries Commissionerate, Udhyog Bhavan, Gandhinagar, for arranging Single Point Sanction of State level clearances in 8 copies alongwith covering letter & requisite fees as stipulated by respective authority. 1.0 PROJECT INFORMATION 1.1 Name And Address of the Promoter/Industrial Undertaking in Full. (BLOCK LETTERS) Name of the Undertaking/Promoter Area Town Taluka District State Pincode Telephone Telex Fax Cable 1.2 Name and Address of the contact person (Local Office) and Telephone No. 1.3 Registration No. and Date (IEM/LOI/EOU/Prov. SSI Registration) 1.4 Registrar of Companies Registration No.(if registered) 1.5 Name of the Directors/ Partners/ Owners with complete address 1.6 Status of Industrial Undertaking (Please tick mark) 1. Central Govt. Undertaking 2. State Govt. Undertaking 3. Co-operative Undertaking 4. Joint /Assisted Sector Undertaking 5. Private Sector Undertaking 6. Partnership Firm 7. Individual Promoter 1.7 Indicate whether this proposal is for (Please tick mark) 1. Establishment of New Undertaking 2. Effecting Substantial Expansion 3. Manufacture of New Articles/Diversification 1.8 Location of the Project Site/Survey No. Villege Taluka District Pincode 1.9 Items of Manufacture : _____________________________________________________________________________ Sr. Name of the product ITC Code Proposed Unit Value in. Mode of No. Capacity Rs. lacs storage (Annual) and handling 1. 2 3 4 5 6 7 _______________________________________________________________________________ (Attach Separate Sheet) ________________________________________________________________________________ 1.10 Details of Plant & Machinery : ________________________________________________________________________________ Sr. Name of the equip. No. Value Horse Dimension and No. Machinery Rs. lakhs Power floor space requirement (in Sq. Mts.) 1 2 3 4 5 6 (Attach Separate Sheet) _________________________________________________________________________________ _________________________________________________________________________________ 1.11 Requirement of Raw materials(Productwise) _________________________________________________________________________________ Sr. Name of Name of Yearly requi Yearly re-Mode of No. Product the raw rement in quirement storage materials quantity in value and handling (In Rs. lacs) 1 2 3 4 5 6 __________________________________________________________________________________ (Attach seperate sheet) 1.12 Details of Manufacturing Process (Please attach a short note on separate sheet including Flow Sheet Showing, Step-Wise Reactions, Points of Generation of Waste Water, gases, solid Waste etc.) 1.13 Investment 1. Land 2. Building 3. Plant and Machinery (i) Indigenous (ii) Imported (a) CIF value (b) Landed Cost (iii) Total [(i) + (ii)(b)] 4. Technical Fees 5. Other Assets 6. Total Investment 1.14 Financial Arrangement 1.15 Employment Existing Proposed Total Local Outside Local Outside Local Outside 1. Workers 2. Supervisory 3. Non­ Supervisory 4. Total 1.16 Schedule Of Project Implementation Or Proposed date of Production 1.17 Specific Information (If any) Date: ________________________ Applicant's Signature Name : Designation : 2.0 (A) ADDITIONAL INFORMATION FOR APPLICATION OF LAND REQUIREMENT (OUTSIDE GIDC ESTATE) 2.1 Name and address of the applicant 2.2 Location of the Project 2.3 Area of Land required 2.4 Detailed Justification for requirement of land (Please attach layout Plan) 2.5 Details on site 2.6.1 Whether the selected land is of old tenure or new tenure? 2.6.2 If the land is of new tenure; details on application filed for converting the land in old tenure 2.7 Details in the prescribed form for bonafied industrial use 2.8 Urban Land ceiling clearance 2.8.1 Does the site attracts ULC 2.8.2 If Yes, details on necessary application filed for exemption 2.9 Application fees (As per State's norms) 2.10 Undertaking (As per State's norms) ___________________________ Signature of Applicant Date Name : Designation : 2.0(B) ADDITIONAL INFORMATION FOR APPLICATION OF LAND REQUIREMENT (As per ordinance 1996) 2.1 Name of the Industrial Undertaking 2.2 Proposed location 2.3 Land Requirement 2.3.1 Area of plot required for industrial purpose including provision for expansion (Area in Sq. Mts.) 2.3.2 Details of construction & land Requirement(In Sq. Mt.) _________________________________________________________________ Built up Area Land Area _________________________________________________________________ Process Plant Utilities Non-factory buildings Storage tanks Effluent Treatment Plant Railway Siding Roads Green belt Any other (Please Specify) ________________________________________________________________________ Note : Please attach layout plan and detailed justification for land requirement 2.3.3 Details of open Space required and purpose 2.3.4 Area of plot required for residential /Housing purpose. 2.4.0 Power Requirement 2.4.1 Connected load in KW 2.4.2 Contracted maximum demand in KVA : 2.4.3 Aggregate installed capacity of the transformer to be installed. 2.4.4 Captive power plant, if any, (MW) 2.5.0 Water Requirement And Environment Control Information 2.5.1 Water consumption, m3/day (i) Domestic (ii) Industrial 2.5.2 Wastewater Quantity, m3/day (i) Domestic (ii) Industrial 2.5.3 Details of Solid Wastes 2.6.0 Any Other Information: Date : Enclosures 1 Affidavit 2 Layout Plan With Justification of land requirement 3 Copy Of LOI/LOP/IEM registration / acknowledgement 4 Schedule of Project Implementation 5 Financing Pattern & Source of fund tie up _______________________ Applicant's signature Name Designation AFFIDAVIT I,_____________ the undersigned, applicant /authorised signatory for ____________do hereby Solemnly affirm and declare as under. (i.) The land of Survey No.____________in village ______________ , Taluka _________________ proposed to be used for industrial project has a clear title. (ii.) The land is not situated within the Urban Agglomeration as defined in clause 21 of section 2 of the Urban Land (Ceiling and Regulation) Act 1976. (iii.) The area of the land exceeds 10 Hectres . (iv.) The area of the land does not exceed four times the area on which construction for a bonafide industrial purpose is proposed. (v.) or The area of the land does exceed four times the area on which construction for a bonafide industrial purpose is proposed because ........ (vi.) The land proposed is not owned by a person belonging to the scheduled tribes. or (vii.)The land or part thereof is owned by the person belonging to scheduled tribes. The sale will be subject to the provision of section 73(AA) of Bombay Land Revenue Code 1879. (viii.) The land proposed is not shown as reserved for a public purpose in the draft or final development plan or draft or final town planning scheme sanctioned under the Gujarat Town Planning & Urban Development Act 1976. (ix.) The land proposed or part thereof is not notified for acquisition under the Land Acquisition Act 1894 or any other law for the time being in force. (x.) The land proposed or part thereof does not fall within the alignment of any road plan prepared by the State Govt. or the command area of any irrigation project. (xi.) The land proposed or part thereof is not situated within thirty metres from the boundary of any land held by the Central Govt. or the Indian Railway Company Ltd., for the purpose of railway. (xii.)The land proposed or part thereof is not situated within fifteen meters of the high voltage transmission line. *** (xii) The land or part thereof is not situated within two kilometres from the boundry of ­ a) an ancient monument declared as ` protected monument ' under sub section (1) of section 3 of the Ancient Monuments Preservation Act, 1904. b) an ancient and historical monument declared as protected monuments ' under sub section (3) of section 4 of the Gujarat Ancient Monuments and Archaeological sites and Remains Act, 1965. c) a forest land or waste land declared as ` reserved forest land ' under section 3 of the Indian Forest Act, 1927. d) a Forest land or waste land known as `protected forest ' under section 29 of the Indian Forest Act, 1927. e) an area declared as ` sanctuary ' under sub section (1) of section 18 of the Wild Life (Protection) Act , 1972. f) an area declared as ` national park ' under section 35 of the Wild Life (Protection ) Act , 1972. *** The condition (xiii) is applicable to only those units who wishes to use such land or part thereof for the purpose of manufacture or storage of any chemical or petrochemical. (xiii) The applicant agrees to comply with the provision of any law for the time being in force or an order or direction of the Central Govt. or State Govt. or any Corporation owned or controlled by such Govt., Govt. Company, local authority or statutary authority in relation to use of land for industrial purpose before the land is put to use for such purpose. (xiv)The applicant abides to commence the use of land for bonafide industrial purpose within three years from the date of such purchase. Signature of Authorised Signatory Name : Designation : Company Name & Address Date : 2.0 (C) ADDITIONAL INFORMATION FOR APPLICATION TO GUJARAT INDUSTRIAL DEVELOPMENT CORPORATION 2.1 Name of the firm with full address 2.2 Area of plot/type of shed required for industrial purpose including provision for expansion(Area in Sq. Mts.) 2.3 Details of construction(Please enclose layout,wherever possible) _____________________________________________________________________________________ Sr. Precise construction Built-up Proposed utility Nature of No. details Area construction 1 2 3 4 5 _____________________________________________________________________________________ N.B. :- Please submit a lay out paln with measurements to enable to evaluate land requirement accurately. 2.4 Details of open Space required and purpose 2.5 Mention minimum space to be left out according to statutory controls (Explosive Act etc.) between process plant and raw material/product/storage area. 2.6 Water requirement Year-wise requirements of filtered/raw water for industrial use in Litres per day for 3 years from the date of production. _________________________________________________ Water req. For per day Cooling Sanitation For Process Total during _________________________________________________ 1 st year 2 nd year 3 rd year 4 th year 5 th year 2.7 Power requirement for three years from the date of production 1 st year ---------KVA 2 nd year ---------KVA 3 rd year ---------KVA 2.7.1 Connected load in KW 2.7.2 Contracted maximum demand in KVA 2.7.3 Aggregate installed capacity of the transformer to be installed in case of HT consumer 2.7.4 Proposed maximum working Hrs. ___________ Per day/per month 2.7.5 Expected date of trial production 2.7.6 Probable date of requirement of power 2.8 Liquid Effluent Please indicate the character­ istics volume/day of liquid eff- luent that will be discharged and its year-wise quantum per day for the first 3 days from the date of production. Qty in litres/day Year1 st year 2 nd year 3 rd year PH ------------------------ (a) Acidity/Alkalinity (PH) (b) Suspended solids (c) Dissolved solids (d) Oil and Grease (e) metals (f) Biochemical Oxygen Demand (g) Chemical Oxygen Demand (i) Temperature C mg/1 mg/1 mg/1 mg/1 mg/1 mg/1 mg/1 mg/1 2.9 Toxic Substances Cyanides,Phenols,Fluorides mg/1 Pesticides DDT, Malathion ETC. mg/1 (a) Please Indicate Indian Standards to be followed for treatment (b) Please attach in a sheet the process of effluent treatment Process Flow-sheet of effluent treatment,detailed design of ETP of the existing / proposed project. Copy of the performance data (pollution parameters) if existing, of the ETP. (c) Please indicate the steps taken for obtaining consent from Gujarat water and Air Pollution Control Board. (N.O.C/consent) attach copy of the Application for N.O.C 2.10 (a) Details of emission of gases & its likely effect on adjoining plants cultivation and habitats (b) Please give details of types of gases Components and their Quantities Attach in a separate sheet (c) Measure proposed to control gases Air Pollution Chimney,scrubber E.S.P and others 2.11 Project implementation Schedule. 1. Indicate the date by which possession of plots/shed is required 2. Indicate the date by which civil work will be undertaken and its anticipated date of completion. 3. Indicate the date by which the plant is likely to be commissioned for commercial production. 2.12 Urban Land ceiling clearance 2.12.1 Does the site attract ULC 2.12.2 If yes, details of application for exemption with commissioner of industries 2.13 Details on application fees : (As required by GIDC as per Annexture `A') 2.14 Undertaking (As required by GIDC as per Annexture `B') (Applicant's Signature) Date : Name : Designation GIDC ANEXURE `A' a) Application fees Rs. 500 per application b) Deposit As under Type of shed Amount of Deposit Rs. A1 Rs. 50000 A2 Rs. 40000 C18 Rs. 30000 C1 Rs. 25000 J Rs. 25000 I Rs. 20000 L Rs. 15000 K Rs. 10000 F.F. FO Etectro Rs. 30000 GIDC ANNEXURE- B PLEASE AFFIX SPECIAL ADHESIVE STAMP OF GUJARAT OF Rs.20/­ Place : Date : To The Managing Director Gujarat Industrial Development Corporation Block 3, Udyog Bhavan Sector 11, Gandhinagar 382 011 Sir, I/We_______________________________________(a firm/Company/Society registered under the______________________________Act)residing at __________________________________________________________________ As I/We am/are interested in establishing an industry in the_____________industrial Area/Estate (1) I/We propose to take ________ type of Shed/Plot____________Sq.Mts. (2) I/We agree to take the Plot/Shed at the cost as may be fixed by the Corporation and also agree to make payment of the cost of Plot/Shed or the manner that may be fixed by the Corporation. (3.) As required by you, I/We pay herewith an amount of Rs.___________ by Demand Draft drawn in favour of Gujarat Industrial Development Corporation to be treated as security deposit for the Plot/Shed applied by me/us. (4.) I/We shall not be entitled to revoke this offer before the expiry of 21 months from the date and if I/We do so, I/We shall not be entitled to claim a refund of the amount of the security deposit paid by me/us with this application. (5.) I/We agree that I/We fail to make the payment of the offer amount of the Plot/Shed that may be offered to me/us by the Corporation within the stipulated period, it will be a breach on my part of this offer and that I/We shall not be entitled to claim a refund of the security deposit paid by me/us. Provided that if no plot/shed is offered to me/us within 21 months from the date of this undertaking by the Corporation. I/We shall be entitled to a refund of the entire amount of the security deposit and this undertaking will stand cancelled. (6) I/We agree and undertake that if I/We accept the offer and make the payment of offer amount of Plot/Shed which is offered to us within 21 months period and subsequently I/We do not execute the agreement or obtain the physical possession of plot/shed and revoke the offer of GIDC. I/We shall not be entitled to claim the refund of the amount from the offer amount to the extent of security deposit , paid by me/us with this application and the Corporation shall be entitled to forfeit an amount equal to the security deposit in addition to 1% deduction of allotment price of Plot/ Shed offered. (7.) I/We understand the provision of the Corporation's regulation regarding allotment of Plot/Shed and I/We agree to take the Plot/Shed as per terms and conditions specified in the forms of the agreement prescribed under regulations. (8.) I/We understand that are required to furnish the prescribed application form duly filled in and to provide the details as desired by the Corporation within 15 days from the date of demanding such information. If I/We fail to provide such information in the prescribed timelimit and if, for want of the said information, the Corporation is not able to send me/us the offer letter within the prescribed time limit of 21 months then I/We shall not be entitled to claim this application. (9.) I/We understand that the Corportion has its own method of calculating the area to be allotted and the allotment of area is also based on the availability of different size of the plots. In view of the above, I/We shall not object the size of the plot that may be offered by the Corporation and on that ground I/We shall not be entitled to claim the refund of amount of deposit paid by me/us, alongwith the application. WITNESS : Yours faithfully, 1) ________________________ ________________________ 2) ________________________ ________________________ 3.0 ADDITIONAL INFORMATION FOR `NO OBJECTION CERTIFICATE' FROM GUJARAT POLLUTION CONTROL BOARD 3.1 Name of the firm with full address 3.2 Purpose for which N.O.C is required (a) Plot allotment (b) Financial help (c) Conversion of letter of intent in to industrial licence (d) Power Additional/New conn. 3.3 Water consumption (i) Domestic (ii) Industrial (a) Processing Litre/day (b) Boiler Litre/day (c) Cooling Litre/day (d) Washing Litre/day (e) Other use Litre/day _____________________________ Total Litre/day ______________________________ 3.4 Wastewater Quantity (i) Domestic (ii) Industrial (a) Processing Litre/day (b) Boiler Litre/day (c) Cooling Litre/day (d) Washing Litre/day (e) Other use Litre/day ---------------------------------- Total Litre/day ---------------------------------- 3.5 Probable quantity of wastewater before and after treatment in respect of the following parameters :- (in mg/I except pH and colour) pH Colour Suspended solid BOD COD Oil and grease Cyanides Heavy Metals Phenolic-Compounds Ammonical-Nitrogen Others 3.6 Final point of disposal of wastewater (give name of River, Nala, Pond or S.No. of land alongwith site plan) 3.7 Detailed description of proposed wastewater treatment plant with schematic diagram, flowsheet/ or detailed engineering drawing as the case may be (feasibility / Treatability study reports must be submitted) 3.8 Details of fuel consumption Coal Mt/day Oil Kl/day Diesel Kl/day Gas M3/day Other 3.9 Details of chimaney and pollutants From stack From stack in gaseous emissions in respect Attached to Attached to of the following Boiler Process vent (in ppm or (in ppm or mg/Nm3) mg/Nm3) Chimney height from ground level & roofs (Seperate for each boiler and process Stack) Particular matter SOx NOx Ammonia Chlorine HCl HF Hydrocarbons Others 3.10 Details of air pollution control measures with schematic diagram flowsheet/detailed engineering drawings, as the case may be(with stack/chimney specifications, scrubber,ESP, bag filters etc.) 3.11 Details of the Hazardous wastes :­ (i) Type of wastes (a) Containing heavy metals (b) Containing cyanide, Phenolic compounds pesticides (c) Oil wastes (d) Organic matters (e) Containing acid/alkali (f) Other solid waste (ii) Quantity of wastes in kg/day (iii) Composition of waste (iv) Details of treatment of the waste (v) Details of waste disposal arrangement ( give survey No. of land, name of village and site plan with capacity of the site) (vi) Precautionary measures proposed to be taken in handling, transportation and disposal of waste. Other safety measures. 3.12 Details of hazardous/toxic chemicals : Name and quantity in MT/day of hazardous/toxic chemicals to be handled. Characteristics of toxic chemicals (Physico-chemical as well as toxicity properties) Precautionary measures proposed to be taken for handling, storage & processing of these chemicals. Disaster Control Plan (For Large Scale units only) Other Safety measures 3.13 Details of Investment 3.13.1 Capital Investment proposed for (Seperate figures for water/ Pollution control plant & monitoring air hazardous waste) 3.13.2 Recurring cost per annum (Seperate figures for water/ air hazardous waste) 3.14 Pollution control Management 3.14.1 Give details of organisation set up for pollution control proposal to have? 3.14.2 Level of experience of the persons in charge of pollution control 3.14.3 Documents to be submitted (a) Copy of NA order (b) Land Possesion Certificate (c) EIA (Only if Investment is more than Rs. 50 crores) 3.15 Application fees (As per Annexure `C') UNDERTAKING 1. I hereby give an undertaking that the above information is correct. 2. I undertake that I/my company will abide by the provisions as well as rules and regulations made under the Water (Prevention and Control of Pollution) Act, 1974; the Air (Prevention and Control of Pollution) Act, 1981; the Environmental (Protection) Act, 1986 and the Water (Prevention and Control of Pollution) Cess Act 3. undertake that I/my company will obtain the consent of the Board under Water, Air and Environmental (Protection) Acts before commencing the production. 4. understand that any condition imposed by the Board while granting NOC will be binding to me/my company. Date: Signature of Applicant Name Designation : GPCB ANNEXURE `C' RATE OF THE N. O. C. FEES INVESTMENT (Rs. in Crore) Rate Of NOC fees Up to 0.25 Rs. 1500 Above 0.25 & up to 0.50 Rs. 2500 Above 0.50 & up to 1.00 Rs. 5000 Above 1.00 & up to 5.00 Rs. 12500 Above 5.00 & up to 10.00 Rs. 25000 Above 10.00 & up to 25.00 Rs. 37500 Above 25.00 & up to 50.00 Rs. 50000 Above 50.00 & up to 100.00 Rs. 75000 Above 100.00 & upto 500.00 Rs. 150000 Above 500 & up to 1000.00 Rs. 250000 Above 1000 & up to 5000.00 Rs. 350000 Above Rs. 5000 Rs. 500000 4.0 ADDITIONAL INFORMATION REQUIRED BY GUJARAT ELECTRICITY BOARD FOR PROCESSING LOW TENSION / HIGH TENSION POWER SUPPLY APPLICATION OF PROSPECTIVE INDUSTRIAL ENTREPRENEURS 4.1 Name of the firm with full address a) Registered Office b) Site -location where power is required Name of village Survey No. Taluka District 4.2 Legal Status of Firm (Proprietory concern, Partnership concern, Cooperative Society, Public Limited Co. Public Limited Co.) 4.3 Type of Power Connection a New Connection- Whether LT/HT (LT supply up to 125 HP and for 100 kva & above HT supply) b Additional power requirement c Re-connection d Temporary Connection 4.4 Details on Power Requirement A Machines Load in H.P KW (Attach Seperate sheet) B Lighting & Non - Industrial power Requirement -HP/KW C Industrial Load required at LT(if load:----HP requirement is up to and including 125HP) D Industrial load requirement at HT basis in---KVA (if power requirement is 100 KVA and above) 4.5 Tentative date by which power is required a For Industrial Production b For regular Production 4.6 Application Fee (As per Board's Conditions of supply applicable to industrial power requirement for LTor HT as the case may be ) 4.7 Undertaking (Firm has to execute standerd agreement as applicable to LT/HT power requirement in the prescribed form with GEB ________________________ pplicant's Signature Name : Date Designation : 5.0 ADDDITIONAL INFORMATION FOR APPLICATION TO NARMADA & WATER RESOURCE DEPARTMENT/LOCAL AUTHORITY FOR WATER REQUIREMENT 5.1 Name of the firm with full address 5.2 Source of water requirement with location 5.3 Quantity of Water Requirement Phasewise Phase I- from --------to--------- MLD phase II-from --------to--------- MLD 5.4 Size of Water Connection 5.5 Detail Plan for water connection 5.6 Recommendation of Industries Department regarding quantity of water demand 5.7 Application fees (As per State's norms) 5.8 Undertakings (As per State's norms) Applicant's Signature Name : Date Designation : 6.0 ADDITIONAL INFORMATION FOR REGISTRATION UNDER INCENTIVE SCHEMES 1995­2000 (Under G. R. No. INC/1095/2000/(1)I/2(I)/4(I) dt. 11/9/95 as amended from time to time) 6.1 Name & Address of the Applicant 6.2 Type of the Project New unit/Expansion/ (Tick Mark) Diversification 6.3 Specify Scheme in which (a) General scheme incentive is required (b) Thrust industries (c) Electronics (d) 100% EOUs (e) Prestigious unit/ Premier Prestigious unit 6.4 NOC From Gujarat Pollution Control Board Ref. No. & date 6.5 Investment in fixed assets for the Project 6.5.1 Investment in Project (Rs. in Lacs) 1. Land 2. Building (Plant & Adm ) 3. Other construction 4. Plant & Machinery 4.1 Indigenous M/cs. 4.2 Imported M/cs. 4.3 Electrification 4.4 Plant for non-con­ vertional source of energy. 4.5 Material handing equipment 4.6 Plant for purification/ desalination of water. 4.7 Pollution Control Equipment 5. D. G. set 6. Technical know-how Fees Total 6.5.2 Investment in Project related infrastructure 1. Residential colony including Hospital, school and sports facilities for workers/ Staff of industrial unit 2 Feeder roads to ind.unit 3. Dedicated pipeline for the water transportation. 4. Deposits paid to GEB for transmission lines. 5. Expenditure on electronic exchange & laying of telecommunication cables. 6. Building for post office & bank if provided by the unit free of cost 7. Training Centres to train local people for employment in the project. 8. Transport facility for the conveyance of the workers. like buses etc. Total 6.5.3 Investment in social infrastructure: 1. Technical Institute like ITI/Polytechnic/Engineering colleges/professional institutes. 2. Establishment of management schools & Private schools. 3. Hospitals 4. Creation of common facilities like drinking water, school rooms,building for hospital in the adjoining villages. Total 6.5.4 Investment in Common & public purpose infrastructure: 1. Construction of dams for storage of water at source. 2. Common pipeline for trans­ portation of water from nearest available source. 3. Common power transmission line. 4. Linkage roads to industrial area from nearest highway & overbridges. 5. Common transport facilities for conveyance of the workers of the industrial area. 6. Common plant for desalination of water for industrial use. 7. Common effluent treatment plant including channel/ pipeline for disposal & recyling of waste water. Total 6.6 Additional information in case of expansion & diversification 6.6.1 Present Capacity, Production & Capacity Utilization ______________________________________________________ Product Capacity Production Capacity Utilization Value in (%) (In Unit) (In Unit) Rs.(lakhs) _____________________________________________________ (Attach Seperate sheet) _____________________________________________________ 6.6.2 Capacity, production & Capacity utilization on expansion/ diversification ______________________________________________________ Product Capacity Production Capacity Utilization Value in (%) (In Unit) (In Unit) Rs.(lakhs) _____________________________________________________ (Attach Seperate sheet) _____________________________________________________ 6.6.3 Investment (i) Investment in fixed asset before undertaking expansion/ diversification (ii) Proposed additional investment in fixed asset (iii)Percentage increase in (ii) over (i) _____________________ Applicant's Signature Name : Date Designation : Enclosures 1 Affidavit 2. Copy of GIDC plot/shed allotment letter or possession letter or land purchase deed, along with N.A. permission for industrial use. 3. Copy of partnership deed/certificate of incorporation. 4. Copy of applicable industrial registration certificate (SSI Reg./IEM/LOI/LOP) 5. NOC of GPCB (if applicable) 6. Project Report. Affidavit I/We hereby declare that I/We have read the Government Resolutions applicable to my industrial unit under General Scheme/Thrust Industries Scheme/Premier & Prestigeous Scheme/Electronic Industries/100% E.O.U.scheme and its amendments issued from time to time. I/We undertake to comply all the conditions stipulated therein. I/We hereby declare that the details given above are true and correct, if any of the information is found to be incorrect and not fulfilling the provisions laid down in the Government Resolution, registration/incentives are liable to be cancelled. Place: Date: Applicant's Signature Name Designation RECOFMT1