Application form for financial asistance for upgradation of quality in SSI sector setting up of testing equipment/testing house. 1 Name & address of the applicant units : a) Director/Partners/ Proprietor's name : b) Office address Telephone No. & Fax No. 2. Brief Hostory of the project : 3 Details of Registration obtained: a) Small Scale Industry registratioon No. & Date : b) I.S.O. 9000 registration No. and date c) Any other registration No. and Date (ISI) 4 Name of the product : a) Existing b) Proposed 5 Capital Investment : a) Land : b) Building : c) Plant & Machinery : (details may be attached seperately) d) Others : e) Working capital margin : 6 Cost of Testing facilities R & D facilities a) Cost of equipments required for testing and R & D (Pl. attach seperate list of the equipments and its individual cost) b) Consultacy fee paid Cost c) Name of RD Constultancy Institution or firm : d) Training cost of personnel : (Pl. give the details of training programme) e) Name of recognised instition connected with R & D and providing training to the personnal f) Fees & administrative expenses connected with acquisition of quality mark. g) Total Cost : 7 Means of Finance of testing facilities/ R & D facilities : a) Term Loan : b) Internal Accruals : c) Others : 8 Details of Product/s for which testing is to be carried out : Name Specification Test for which machinery equipment is purchase 9 Details of technical personnal employment/ to be employed for the project : Sr. No. Name Age Qualification Experience & R & D 10 Details of Production of Last three years (if applicable) Item Qty. Value Qty. Value Qty. Value I/ We hereby certify that the particulars given above are to the best of my/our knowledge and belief are true and correct and no materials facts has been concerned or withheld. Place : Date : Signature of applicant firm NOTE : Unit has to product statement of all expenditure (like land, building, Plant & Machinery, testing equipments and other expenses) certified by a Chartered Account to the effect that items of expenditure conform to those laid down in the scheme.
