GOVERNMENT OF GUJARAT COMMISSIONERATE OF INDUSTRIES APPLICATION FORM FOR PROVISIONAL REGISTRATION AS SMALL SCALE INDUSTRIES (TO BE FILLED IN DUPLICATE) 1. Name of Unit/ Applicant 2. Complete Postal Address: Tel: Pin code 3. Category: SSI -1, ANC-2, SSSBE-3, TINY-4, EOU-5, GSI-6 (BOXES MARKED (*) TO BE FILLED IN BY OFFICE ) 4. Llocation : Place/town Tehsil/taluka District. State 5. Type of Organization: Proprietory-1, Partnership-2, Pvt.Company-3, Co-operative-4, Others-5 6. Nature of Activity Manufacturing/assembling (01) Processing (02) Job Work (04) Repairing/Servicing (08) Note: For any combination of activities, add the respective codes to get the required code . 7. Main items of manufacture/activities. I) Name Code. ii) Name Code iii) Name Code iv) Name Code v) Name Code 8. Investment in Fixed Assets (Rs. in '000) I) Land ii) Building iii) Plant & Machinery iv) Other Fixed Assets TOTAL 9. Investment in Plant and Machinery (Original Value in '000) Note: Should exclude items whose value is not taken into account while computing the investment. Please enclose project profile in case value of investment in Plant & Machinery exceeds Rs. 40 lacs. 10. Power Load. 11. Employment I) Managerial & Office Staff. ii) Supervisor Workers. 14. Date of Commencement of Production (estimated) Signature of Applicant (Authorised Person) Name of Proprietor/Partner/Managing Direcrtor. + FOR OFFICE USE ONLY Application No. NIC Code. Block Code District Code State Code. Location of unit (Conforming -1, Non confirming -2) Whether the items of manufacture/activity require an industrial licence YES-1 NO. 2 (NO industrial licence is required for items listed in Schedule -II of the licencing notification dated 25.7.1991 if it unit employees less than 50/100 workers with/without power) PROVISIONAL REGISTRATION The application is accepted for Provisional Registration as a SSI/SSSBE unit for the manufacture of items/activities as stated in the application form. Provisional Registration No. Date of issue Category of unit (S.No.3) SIGNATURE NAME & DESIGNATION OF REGISTERISNG AUTHORITY. 1. The endorsed application form is a part of the certificate of registration. 2. The provisional registration is valid for a period of five years from the date of issue 3. The provisional registration will automatically lapse at the end fo the validity period or the date of commencement of production, whichever is earlier. 4. If an applicant/unit is unable to set up the unit within the validity period the applicant/unit has the option to apply afresh for provisional registration using standard procedure. 5. The provisional registration is given to enable the unit to obtain all facilities/clearance etc., required in the preproduction stage. 6. The provisional registration is subject to any or all conditions that may be imposed by the Registerisng Authority. ***
