INDUSTRIAL ENTREPRENEURS' MEMORANDUM 1. This format is is to be used for submission to the Central Government in the Secretariat for Industrial Assistance, for the purposxe of record, a memorandum under the Industries (Development and Regulation) Act, 1951 (65 of 1951) in respect of proposals covered by the Notification No. 477(E) dated 25th July, 1991 of the Department of Industrial Policy & Promotion, Ministry of Industry, Government of India as amended from time to time. 2. The application should be submitted to the Secretariat for Industrial Assistance (SIA), Department of Industrial Policy & Promotion, Ministry of Industry, Udyog Bhavan, New Delhi - 110 011 in 6 (six) copies alongwith a crossed demand draft for Rs. 1000/- drawn in favour of the " Pay and Accounts Officer, Department of Industrial Development, Ministry of Industry", payable at the State Bank of India, Nirman Bhavan, New Delhi. 3. Entrepreneurs may go through the 'Note for Guidance for Entrepreneurs' carefully before filling up the details in the IEM. The note contains relevant extracts of licensing provisions, a note on NIC Classification System and guidelines for filling up the Memorandum. ______________________________________________________________________ For Official Use Only. Memorandum No. Date Date Month Year _____________________________________________________________________ 1. Details of Bank Draft Amount Rs. Draft No.________________________________ Draft Date Drawn on _______________________________ (Name of the Bank) Payable at _______________________________________________________ II Name and Address for Correspondence of the Promoter/Industrial Undertaking in full (BLOCK LETTERS) Name of the Undertaking/ Promoter Area Town Tehsil/Taluk District State Pincode Telephone Telex Fax Cable III Registrar of Companies Registration No. (If registered) IV Status of Promoter/Industrial Undertaking IV(1) Status of the Promoter/Industrial Undertaking (Please tick ( ) the appropriate box) Central Government Undertaking Private Sector Undertaking State Government Undertaking Individual Promoter State Industrial Development Corporation Assisted Sector Undertaking Joint Sector Undertaking Co-operative undertaking IV(2) Indicate whether this proposal is for (Please tick ( ) the appropriate box) Establishment of a New Undertaking Change of location Effecting Substantial of Expansion Change of ownership/name of Company Manufacture of New Articles Graduation to Medium Scale Others* *Please specify in a separate sheet. IV(3) Whether the proposal is in lieu of any other IEM already acknowledged/letter of intent/Industrial licence held. Yes No (If Yes, indicate the previous Reference number and date, attach the previous reference in original) Reference No. __________________Date ______________ V. Location V(1) Location of the undertaking Place/Town Tehsil/Taluk District State Pincode V(2) Please Indicate whether the proposed location is : (a) Within 25 Kms from the periphery of a city having population above the million according to 1991 census. Yes No (b) Located in an industrial area/industrial estate designated/set up prior to 25.7.1991. Yes No V(3) (a)Is the IEM being filed for electronics, computer software or printing industry Yes No (b)Is the IEM being filed by a small scale unit graduating to medium scale for the unit located within 25 kms. from periphery of a city with more than 1 million population. Yes No (c)Is the IEM being filed by existing unit for new articles without additional investment Yes No VI Item(s) of Manufacture: In case of more than one item supplementary sheets may be used (Specimen of supplementary sheet is enclosed). In case of proposals for Drugs and Pharmaceuticals, applicants should also fill up the Annexure. VI (1) Item of Manufacture* (a) (NATIONAL INDUSTRIAL CLASSIFICATION OF ALL ECONOMIC ACTIVITY (NIC), 1987 NIC No. (b) Item Description (c) Proposed Annual Capacity (d) Existing Capacity, (if applicable) (e) Total Capacity after expansion (f) Unit of Capacity VI(2) Description of Activities to be undertaken (if , no manufacturing envisaged) __________________________________________________________ __________________________________________________________ __________________________________________________________ VI(3) BY-PRODUCT/CO-PRODUCTS; NIC No. Item Description Proposed annual capacity Existing capacity, (if applicable) Total Capacity after expansion Unit of capacity NIC No. Item Description Proposed annual capacity Existing capacity, (if aplicable) Total Capacity after expansion Unit of capacity *NOT TO BE FILLED IF NO MANUFACTURING IS ENVISAGED. NIC No Item of Description Proposed annual capacity Existing capacity, (if applicable) Total Capacity after expansion Unit of capacity VI(4) Raw Material (including Components, intermediates and packing materials) ITEM(S) QUANTITY UNIT VALUE VII Whether the item(s) of manufacture/by-product/co/product is covered in Schedule I (Reserved for Public Sector), Schedule II (under compulsory Licensing) or Schedule III (Reserved for manufacture in Small Scale Sector) of Notification No.477(E) dated 25th July 1991/as amended from time to time. Schedule-I Schedule-II Schedule-III Yes Yes Yes No No No VIII Investment Existing Proposed (Amount in Rupees) (Amount in Rupees) (a) Land (for rented premises cpitalised value of the same to be indicated (b) Building (c) Plant & Machinery (I) Indigenous (II) imported (a) CIF Value (b) Landed Cost (iii) Total {(i)+(ii)(b)} IX FINANCING PATTERN Existing Amount Proposed Amount Total Equity in Rupees in Rupees (I) Resident Indian (iii) Foreign Total Borrowings (I) Public Financial Institution (ii) Public Borrowing (iii) Other Sources Promoters' Contribution IX(1) Whether Foreign Technology agreement is envisaged : (Please tick ( ) the appropriate box) Yes No IX(2) Whether Foreign Investment is envisaged : (Please tick ( ) the appropriate box) Yes No X. Employment (All figures in number) Existing Proposed (a) Supervisory (b) Non-Supervisory Total XI. Expected Date of Commencement of Commercial Production Date Month Year Declarations I/We hereby certify that this memorandum conforms to all the conditions stipulatedin the Notification No. 477(E) dated 25th July 1991 and amendments thereof regarding exemption from Industrial Approvals. I/We hereby further declare that the above statements are true and correct to the best of my/our knowledge and belief. -------------------------------- Signature of Promoter(s) __________________ (Name in Block Letters) ------------------------------------- (Designation of Promoter) Place: ______________ Date Month Year SPECIMEN Supplementary Sheet referred to in Column VI VI(1) Item(s) of Manufacture (a) Item Code (NIC No.) (b) Item Description (c) Proposed Annual Capacity (d) Existing Capacity (If, applicable) (e) Total Capacity after expansion (f) Unit of capacity VI(2) BY-PRODUCT/CO-PRODUCTS; NIC No. Item Description Proposed annual capacity Existing capacity, (if applicable) Total Capacity after expansion Unit of capacity NIC No. Item Description Proposed annual capacity Existing capacity, (if applicable) Total Capacity after expansion Unit of capacity NIC No. Item Description Proposed annual capacity Existing capacity, (if applicable) Total Capacity after expansion Unit of capacity VII Whether the item(s) of manufacture/by-product/co/product is covered in Schedule I (Reserved for Public Sector), Schedule II (under compulsory Licensing) or Schedule III (Reserved for manufacture in Small Scale Sector) of Notification No.477(E) dated 25th July 1991/as amended from time to time. Schedule-I Schedule-II Schedule-III Yes Yes Yes No No No -------------------------------- Signature of Promoter(s) __________________ (Name in Block Letters) ------------------------------------- (Designation of Promoter) Place: ______________ Date Month Year PART B To be submitted at the time of commencement of commercial production to the Secretariat for Industrial Assistance (SIA) Department of Industrial Policy & Promotion, Udyog Bhavan, New Delhi-110 011 in six (6) copies. _____________________________________________________________________________________ I Reference Number __________________________________ II Actual Date of Commencement III Actual Investment: Existing Actual (Amount in Rupees) (Amount in Rupees (a) Land (for rented premises, Capitalised value of the same to be indicated (b) Building (c) Plant & Machinery (I) Indigenous (ii) Imported (a) CIF Value (b) Landed Cost (iii) Total (i)+(ii) (b) IV Items of manufacture: (In case of more than one item supplementary sheets may be attached.) *NIC No. *ITC Code V. Employment Proposed Actual (a Supervisory (b) Non-Supervisory Place:________________ Signature of Promoter(s) ______________________ (Name in Block Letters) _________________________ (Designation of the Promoter) Date Month Year TO BE FILLED WHEREVER APPLICABLE
