1. Name of the applicant and full permanent address : 2. Present address : 3. Name and address of the existing/proposed industry : 4. Items manufactured/proposed to be manufactured in the Industrial unit with quantity : 5. Nature and quantity of raw materials used / proposed to be used : 6. Details of the plot required a) Plot No. : b) Extent : c) S.No. : d) Name of village : e) Name of Taluk : 7. If existing Industry present location and reasons for changing the same : a) Building b) Manufacturing 8. The total estimated cost for a) Building b) Machinery and equipment i) Indigenous ii) Imported c) Working capital 9. Nature of management : a) Proprietary : b) Partnership : c) Registered company : d) Industrial co-operative : 10. The position held by the applicant in undertaking and the name of the person who is authorized to execute the agreement on behalf of the organization : 11. No. and date of chalan to prove remittance of earnest money : I have read and understood the rules prescribed for hire purchase of plots in the development plot of Kerala State as per G.O. No. and I hereby declare to abide by them Place: Signature of the Applicant Date: SPECIMEN APPLICATION FORM FOR ALLOTMENT OF LAND ON LEASE FOR INDUSTRIAL PURPOSE IN DEVELOPMENT AREA/ DEVELOPMENT PLOT 1. Name of the applicant in full : 2. Present address : 3. Previous address (full address) : 4. Survey Number and other details of the land applied for 5. Extent of land applied for : 6. Boundaries : 7. Purpose for which the lease of land requested : 8. Necessity, desirability and suitability of the land for the purpose : 9. Advantage in conducting the industry in the area : 10. Why land is required in the locality state whether other lands are not available : 11. Whether applicant is not prepared to pay the value of land immediately and whether he is prepared to pay the rental : 12. Capacity of the applicant to start and conduct the industry : 13. Period within which the applicant will use the land for industrial purpose : DECLARATION I do here by declare that the details furnished in the application are correct. Place: Signature of the Applicant Date: 1. Name of the applicant : 2. Full Postal address : 3. Name and address of the industry : a. Whether existing or proposed b. S.S.I. Registration No. and date 4. Details of industry now run or proposed : 5. Type and number of the shed (s) in the Industrial Estate new occupied if any, showing also the name of the industrial Estate : 6. Name of the Industrial Estate in which the applicant seeks allotment of shed (s) on hire purchase basis showing also the type and number of the shed (s) required : 7. Do you require any additional land (beyond the free space ) along with the shed(s) applied for ? If so furnish full details of the additional land required : 8. Number of employees a. Existing b. proposed to be appointed 9. Details of Machinery : a. already installed b. proposed to be installed 10. Any other information which the applicant desire that the Corporation should consider in this regard : The industry I am running/propose to start comes within the purview of a small scale Industry. I have read and understood the Corporation's Rules for allotment of sheds in Industrial Estates, Kerala on Hire Purchase basis and I shall abide by them. Place : Signature of the applicant Date: APPLICATION FORM FOR ALLOTMENT OF LAND/SHEDS UNDER LEASE IN INDUSTRIAL ESTATE/ MINI INDUSTRIAL ESTATE 1. Name of the applicant : 2. Full Postal Address showing particulars of village and Taluk and District : a. Permanent b. Present 3. a. Name and address of the Industry b. Whether existing or proposed c. SSI Registration No. and date 4. Type and number of shed (s) applied for , with location of the Estate : 5. a. If the applicant is a partnership firm, is the applicant a firm registered under the Partnership Agreement and acknowledgement of registration are produced : b. If the applicant is a Co-operative Society whether the following documents details are produced : 1) Certificate of Registration 2) Regd. Bye-laws 3) Name and address of the Director 4) Resolution of the Board of Directors to sign lease agreements binding on the society : c. If the applicant is a Company Registered under the Indian companies act, whether the following documents/details are produced : 1) Certificate of incorporation 2) Regd. Memorandum and articles of Association of the company 3) Name and addresses of the Directors 4) Resolution of the Board for obtaining shed in Industrial Estate on lease basis 5) Previous Balance Sheet 6) Resolution authorizing any Director to execute lease agreement so as to bind the Company 6. Are you an occupant of the Estate? If so, show details of shed (s) occupied duration of lease and balance of dues in respect of shed (s) occupied : 7. Number of employees a) Existing b) Proposed to be appointed 8. Is your scheme approved by the Industries Development Commissionarate? If so, is evidence of approval produced along with the approved scheme? : 9. Any other information which the applicant desires that the corporation should consider in this regard : The Industry I am running/propose to start comes within the preview of a small scale industry. I have read and understood the Corporation's Rules for allotment of sheds in Industrial Estates on lease basis and I shall abide by them. Signature of the Applicant/ Authorised Representative 1. Name of the applicant and full permanent address : 2. Present address : 3. Name and address of the existing/proposed industry : 4. Items manufactured/proposed to be manufactured in the Industrial unit with quantity : 5. Nature and quantity of raw materials used / proposed to be used : a) Imported b) Indigenous 6. Details of the land and shed required a) Land and shed No. b) Extent c) Survey No. d) Name of Villages e) Name of Taluk 7. If existing Industry present location and reasons for changing the same : 8. The total estimated cost for : a) Building b) Machinery & Equipments a. Imported b. Indigenous c. Working capital 9. Nature of management : a) Propretary b) Partnership c) Registered Company d) Industrial co-op: Society 10. The position held by the Applicant in undertaking and the name of the person : who is authorized to execute the agreement on behalf of the organization 11. No. and date of chalan to prove remittance of earnest money : I have read and understood the rules prescribed for hire of shed and land in the District Mini Industrial Estate Co-operative Society of Kerala State as per the Rules and conditions of the society and I hereby declare to abide by them. Place : (Signature of the Applicant ) Date:
