APLICATION FORM PROVISIONAL REGISTRATION AS SMALL SCALE INDUSTRIES Write/type in block (in capital letters) 1. NAME OF THE UNIT ________________________________________________ 2. PIN CODE ________________________________________ 3. DATE ________________________________________________________________ 4. QUANTITY ___________________________________________________________ 5. AMOUNT (Rs in Thousand) ______________________________________________ 6. FILL UP APPROPRIATE CODE IN THE BLOCKS WHENEVER APPLICABLE 7. IF NA, FILL UP _____________________ CATEGORY : SSI 1,ANE 2, TINY 3,SSAE 4, EOU 5 WHERE : SSI: Small Scale Industries, ANC. Ancillary Industrial undertaking, SBE: Small Scale Service and Business enterprise Tiny: Tiny enterprise, EOU: Export Oriented and NA: Not applicable. FORM NAME OF THE UNIT / APPLICANT ______________________________ ADDRESS FOR COMMUNICATION ________________________________ TEHSIL/TAULAK _______________________________________________________ DISTRICT _____________________________________________________________ PINCODE ______________________________________________________________ TYPE OF ORGANISATION ______________________________________________ (Proprietary I,Partnership 2, Pvt Company 3, Cooperative 4) DATE : SIGNATURE OF APPLICANT NAME OF APPROPRIATE PERSON/
