APPLICATION FOR INVESTMENT SUBSIDY I/We ............................... as per resolution No. ....... dated ..... have been authorised to and hereby do apply for Investment Subsidy for M/s. ..................... .................. for an amount of Rs. ......... (Rupees .............................. only) The details are as under: (1) Name and address of the applicant unit : (2) Location of factory : (3) SSI Provisional Regn. No. & Date : (4) SSI Permanent Regn. No. & Date : Reference No. & Date SIA Ref. No. & Date / IL No. & Date : (5) Constitution of unit: Proprietory / : Partnership/Company/Society (6) Whether Director Board has taken : resolutions 1) To apply for subsidy : 2) To authorise undersigned to do : everything necessary for disbursement of subsidy ( if yes, attach copies ) (7) Products manufactured : (8) Date of commencement of : commercial production In case Expansion/Diversification/ Modernisation Quantity Value (9) Pre-expansion/diversification/ : modernisation capacity (10) Post-expansion/diversification/ : and modernisation capacity (11) Percentage increase : (12) Period during which expansion/ diversification/modernisation executed : Form To (13) Date of re-starting production after completing expansion/diversification/ : modernisation (14) (15) Land (1) Extent Survey Nos. Village Taluk (7) Valuation by financing Institution Banks/KIIDC (16) If land is leased, whether registered lease deed for 10 years or more exists (17) Development costs of land: (1) Levelling or filling charges certified by CA (2) Levelling or filling charges as per valuation of Engineer (18) Building: (1) Plinth area of factory shed and other industrial structures (2) Cost of building certified by C.A. (3) Cost of building as valued by Engineer (4) Plinth area actually in use for industrial purpose (19) Plant & Machinery: (Same format to be used fore claims for testing equipment, generator sets and pollution control devices & facilities) 1. Value as certified by C.A. : 2. List of Machinery : Investment considered for subsidy before expansion/ diversification/modernisation Investment in the course of expansion/diversification / modernisation (1) (2) Land value : Land development cost : Building : Plant & Machinery : Electrification : Testing equipment : Generator / Pollution control device : Total : (2) Document Registration No. & Date : (3) Cost of land as per document : (4) Tahsildar's valuation per cent of land : (5) Tahsildar's total valuation for land (6) Extent of land used for industrial purpose by unit Name of machinery Income No. & date Name of Supplier Cash Receipt /D.D. No. & date. Value including all taxes (1) (2) (3) (4) (5) 3. Value of items bought to fabricate : plant etc. as certified by Chartered Accountant 4. Value of fabricated plant etc., as : valued by Chartered Engineer 5. List of items other than : identifiable machinery Name of Item Invoice No. & date Name of Supplier & address Cash Receipt /D.D. No. & date. Value (1) (2) (3) (4) (5) (20) Electrification : (1) Value as certified by Chartered Accountant : (2) Valuation by Electrical Inspector Assistant Executive Engineer/ Kerala State Electricity Board/ Kerala State Industrial Development Corporation/ Kerala Financial Corporation/Chartered Engineer if claim exceeds Rs. 50,000/(21) (a) Amount realised by sale of assets scrapped in the course of modernisation : (b) Written down value of assets : scrapped in the course of modernisation (22) Subsidy previously availed: (1) Under investment subsidy : (2) Any other source like MPEDA et : (23) Total fixed capital investment : claimed for subsidy (24) Subsidy applied for : (25) Name of financing bank branch : I have read the rules and conditions of the Investment Subsidy Scheme and undertake to abide by them. I also certify that all the above facts are true to the best of my knowledge and belief. Signature of applicant for and on behalf of the Applicant Unit EMGINEER'S CERTIFICATE 1. Certified that I inspected ................... areas in Survey Nos. ..... of ............. village in ........ Taluk in ........................... District belonging to M/s. .......................... and in use as industrial land. The valuation of levelling work of ................acres for an average depth of ........ feet is Rs................ 2. Certified that I inspected the building of No. ......... belonging to M/s................................... with reference to the plan thereof approved and sanctioned by the local body. The structure-wise valuation is as follows: - Plinth Area Valuation Factory building : Office building : Godown : Laboratories : Guest-house : Canteen, Rest-house : Compound wall : Other : The plinth area of the unit's buildings as per the approved plan is ......... On inspection the plinth area of the structure in use for industrial purpose is seen to be ............. The value of this structure is .............. .............. . Certified further that this is a new structure entirely. Place: Assistant Executive Engineer, Date: PWD/SIDCO/Any other Govt. Department KFC/KSIDC CERTIFICATE BY ELECTRICAL INSPECTOR Certified that I have inspected and valued the electrification work of .................................... ................ and that value of electrification work need for industrial purpose is ............................. KSEB/Electrical Inspectors/ KFC/KSIDC/Chartered Engineer. CERTIFICATE OF VALUATION BY CHARTERED ACCOUNTANT We hereby certify that M/s. .......................... .................................... have acquired the following assets: (In case of expansion/diversification/modernisation, give pre-expansion Fixed Capital Investment and expansion fixed capital investment for each item separately) Fixed Assets: 1. Cost of land including documentation : charges 2. Cost of land development : (Levelling or filling costs) 3. Cost of factory sheds and other : industrial buildings 4. Cost of plant and machinery bought : ready -made 5. Cost of plant and machinery 6. Industrial electrification costs (wiring costs, : OYEC costs, transformer costs) 7. Testing equipment costs : 8. Diesel generator (including installation costs) : 9. Costs of pollution control devices : Total : We have checked the books of accounts of the units, the invoices, cash bills and cash receipts and certify that the aforesaid information is true. We also certify that the aforesaid items have been duly paid for and no credit is raised against them in the books of the unit. Place: Date: Chartered Account CERTIFICATE FROM BANK/FINANCING INSTITUTION WHICH HAS FINANCED FIXED CAPITAL INVESTMENT OF CLAIMANT UNIT We certify that we have disbursed a term loan of Rs.......... (Rupees ..... ................................... only) . .................................... to M/s their fixed capital investment of Rs. ..... as on ..... The valuation of assets of this unit as per our records and which we have adopted for financing them is as follows. 1. Land used for industry ( Extent ..... ) : Rs. 2. Building used for industry (Plinth area .....) : Rs. 3. Plant & Machinery : Rs. 4. Electrification : Rs. 5. Generating set : Rs. 6. Pollution control facility : Rs. 7. Testing equipment : Rs. 8. Total Fixed Capital Investment : Rs. (Seal) Signature: Manager of Financing Bank/Institution FORM OF AGREEMTN ON STAMP PAPER WORTH RS. 50/- Whereas I/We .........................have applied for ................................ investment subsidy and whereas I/We have been granted investment subsidy of Rs. ....... .................................... the receipt of which is hereby acknowledged. Now this deed witnesseth. I/We undertake to abide by the terms and conditions stipulated for the purpose of sanction and disbursement of investment subsidy; I/We undertake to remain in commercial production for a period of at least 5 years from the date of disbursement; I/We further agree that no change of location of the unit or any substantial contraction or disposal of fixed capital investment will be made within the period of 5 years without the prior approval of Government; I/We further agree to furnish to the disbursing agency annual audited statement of accounts; I/We also undertake to refund to Government any sums received as subsidy if: i) My/our unit goes out of production within 5 years of receipt of subsidy, or ii) I/We violate any of the terms and conditions stipulated for the purpose of investment subsidy, or iii) The disbursing agency intimates me/us in writing that subsidy has been obtained by me/us by misrepresentation or by furnishing of false information as to an essential fact in my/our application for subsidy and supporting documents submitted by me/us, together with such interest as might be prescribed by the Government or in the absence of any such fixation with interest at 14% I/We also undertake to refund to Government any overpayment to me/us by the disbursing agency on account of investment subsidy made in excess of my/our actual entitlement upon being intimated of the fact by the disbursing agency; I/We further agree that the provisions of the Kerala Revenue Act will be invoked against me/us in case I/We default on amounts demanded from me/us under the above provisions and that all amounts due to Government shall, in case of default, be recoverable as if they are arrears of land revenue under the provisions of the Kerala Revenue Act for the time being in force. Place: Date: Signature: (For himself and for the unit) Witnesses: 1) 2)
