PART - 1 GENERAL PROJECT INFORMATION 1. PROJECT INFORMATION 1.1 NAME & LOCATION OF INDUSTRIAL UNIT/UNDERTAKING IN FULL (Please fill in BLOCK LETTER) Name of Undertaking/Unit ......................................................................................................................................................................................................................................................Area ................................................................................................................. Town/City..........................................................................................................Tehsil/Block ............................................ District .......................................... State ......................................................... Pin code ........................................ Phone : STD code .................................... Number (s) ................................... Fax : STD code....................................... Number (s) .................................. Telex : ..................................................... Cable ........................................... E-mail : ............................................................................................................. 1.2. LOCAL OFFICE (CONTACT PERSON) (Please fill in BLOCK LETTER) Name .................................................................................................................................... Address................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. Phone : STD code .................................................... Number(s) ........................................ Fax : STD code .................................................. Number(s) ........................................ E-mail : ................................................................................................................................. 1.3. In case of IEM LOI EDU (Please tick mark) Registration No: Date D D M M Y Y Y Y 1.4 Period up to which the registration is valid Date D D M M Y Y Y Y 1.5 Registration number allotted by Registrar of Companies (if Registered) Registration No. : 1.6 DETAILS OF THE DIRECTORS/MD (Please fill in BLCOK LETTER) Name ............................................................. Designation .............................. Street/Area ........................................................................................................ Town/City ......................................................................................................... Tehsil/Bock ................................................. District ...................................... State ............................................................ Pin code ..................................... Phone : STD code ..................................... Number(s)................................... Fax : STD code ...................................... Number(s).................................... E-mail : ............................................................................................................ 1.7 STATUS OF PROMOTER/INDUSTRIAL UNDERTAKING (Please tick mark) Central Govt. Undertaking Assisted Sector Undertaking State Govt. Undertaking Private Sector Undertaking State Industrial DevelopmentCorpn. FDI/OCB Co-operative Undertaking NRI Joint Sector Undertaking Individual Promoter 1.8 CATEGORY OF THE INDUSTRIES (Guidelines may be referred) Red Orange Other 1.9 SCALE OF INDUSTRIES (With reference to provisional/PMT/SIAI/LOI/ Industrial Licence) Large Medium Small 1.10 Whether industry proposed to be located in Growth Centre/Industrial area or any other area In Growth Centre/Industrial area: Yes No Specify Name .................................................... 2. LAND REQUIREMENT AND UTILISATION 2.1 For main production shed (m²) : ....................................................... 2.2 For godown (m²) : .............................................................................. 2.3 For office chowkidar room (m²): ......................................................... 2.4 Total area of land proposed to be acquired (m²) ................................... 2.5 Total covered area(m²) 2.6 Any other details : ........................................................................................... 3. INDICATE WHETHER THIS PROPSAL IS FOR: (Please tick mark) Establishment of new Undertaking Effecting Substantial Expansion Manufacture of new Articles Continuation of existing Process/ operation/unit Others, please specify :......................................................................................... 4. ITEMS OF MANUFACTURE 4.1 Main Products: Sl.No. Name of the Product Item Installed Unit Value Mode of Code Capacity (Rs.) Storage & (ITC/NIC) (Annual) Handling ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. 4.2 By-Products: S.No. Name of the Product Item Code Installed Unit Value Mode of (ITC/NIC) capacity (Rs.) Storage & (Annual) Handling ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. ......... .................................. ............. ............. ........... ........................ .................. 5. DETAILS OF MACHINERY ITEMS S.No. Name of the equip- Purpose No. Horse Value Dimension and ment/Machinery Power (Rs.) floor space requirement (Sq.Mts.) ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... ....... ............................... ................. ....... ............ ..................... ...................... 6. REQUIREMENTS OF RAW MATERIALS (Product-wise) S.No. Name of the Name of the Yearly Yearly Indigenous Mode of Product raw materials require- require- or Storage & ment ment imported Handling in Qty. in Value ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... ........ ..................... ........................ ............... ............... ................ ..................... 7. DETAILS OF MANUFACTURING PROCESS: (Please attach a short note on separate sheet and give reference here) ........................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... Flow chart showing step-wise Reactions, Points of Generation of Waste Solids, Water, Gas effluents with their physical, chemical components and quantities. 8. ESTIMATE PROJECT COST/PROPOSED INVESTMENT (Rs. in Lakhs) 8.1. Land : .................................................................................................................... (For rented premises, capitalized value of the same be indicated) 8.2. Building : .............................................................................................................. 8.3. Plant and Machinery (i) Indigenous : .......................................................................................................... (ii) Imported (a) CIF value : ...................................................................................................... (b) Landed cost ..................................................................................................... (iii) Total [(i) + (ii) (b)] : ................................................................................................ 8.4 Total Investment In plant & machinery : ........................................................................................... Fixed Capital [8.1 + 8.2 + 8.3 (iii)] : ....................................................................... Recurring Capital : ................................................................................................. 8.5 Technical Fees : ....................................................................................................... 8.6 Total Investment in other Assets: .......................................................................... 9 EMPLOYMENT (In number) S.No. Type Existing Proposed 1. Managerial ............................................ .................................... 2. Supervisory ............................................ .................................... 3. Skilled ............................................ .................................... 4. Semi-skilled ............................................ .................................... 5. Unskilled ............................................ .................................... Total ............................................ .................................... 10 Whether the proposed project is Financed / Sponsored by Central Govt./State Govt. / Private Sector/Public Sector: ................................................................................................................................................ 11 No. of working shifts in the unit : ......................................................................... 12 Present State (Land allotted /Licence issued/Letter of Intent converted into industrial licence etc.) 13 Year/Month by which the unit shall be commissioned Date D D M M Y Y Y Y 14 Year/Month by which the unit shall be operating Date D D M M Y Y Y Y 15 POWER 15.1 Power required for the unit: ................................................................................ 15.2 Contracted maximum demand in KVA : .......................................................... 15.3 Connected load in KW/H.P. :................................................................................. 15.4 Aggregate installed capacity of the transformers to be installed by the entrepreneur in case of HT above 60 H.P. (HT means voltages 11 KV and above) :................................................................................................................... 15.5 Probable date of requirement of power : ........................................................... 15.6 Power required for running of ETP/PCM : ..............ETP ............PCM............. 16 WATER 16.4 Ground water details: (For office use, in case the unit is proposed to be set up in any Growth Centre / Industrial area) a) Depth of water level : .............................................................................................. b) Quality of the water: .............................................................................................. c) Ground water yield : ............................................................................................. d) Ground water availability of the block in which unit is proposed to be located: ............................................................................................................................................... 16.2 Total water consumption (daily /monthly): Source : Ground water ......................................... Surface water .................................. 16.3 Total water generation per day : .......................................................................... 16.4 Total waste water discharge per day : ................................................................ 16.5 Water Balance : ................................................................................................... 16.6 Mode of disposal of waste water : ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. 17.1 FUEL CONSUMPTION Monthly consumption of Coal/Diesel/Furnace Oil/Natural gas/Wood etc. 1. Coal ......................................................................................................................... 2. Diesel ....................................................................................................................... 3. Furnace Oil .............................................................................................................. 4. Natural gas ............................................................................................................... 5. Wood ........................................................................................................................ 17.2. SPECIFIC INFORMATION (if any) : ............................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... Applicant's Signature Date : Name : Designation :
