NSTFDC FORMAT NO.1 FORMAT OF APPLICATION FOR FINANCIAL ASSISTANCE FOR INDUSTRIAL AND OTHER SERVICES SECTOR ACTIVITIES (THIS IS ONLY A FORMAT AND NOT AN APPLICATION FORM) 1. DETAILS OF PROMOTER(S): a) Name & Address of the Promoter(s) : b) Constitution: Proprietorship/Partnership/ : Cooperative Society c) Present activities of the Promoter (s) : 2. PROPOSED ACTIVITY : a) Name of the Scheme: b) No. of Unit(s) : Rural : Urban : Total : c) No.of applicants: Per Unit Total for....Units (Owners of Assets only) ------------ ------------------------- Rural Urban Rural Urban ------ ------- ------ ------ i) Educated/uneducated unemployed/ underemployed ii) Women iii) Others ------ ------- ------ ------ Total ------ ------- ------ ------ d) Location(s) of Unit(s) : 3. COST OF THE PROJECT (Rs. In Lakhs) S . No 1. Items Land (Area & Rate.) Cost Per Unit Total for ..units. 2. Building /Civil Works 3. Plant &Machinery (Annex.I) 4. Misc.Fixed Assets 5 6. Working capital/ ( Annex .II) Insurance, interest during implementation period & Cost escalations etc. 7. Others, if any Total : 4 MEANS OF FINANCE: (Rs. In Lakhs) S.No. Source Per unit amount % Total for.. units 1. Promoter's Contribution 2. Subsidy 3. Loan - SCA 4. 5. Term Loan - NSTFDC Others, if any(specify) ---------- --------- -- ----------- Total ---------- --------- ----------- 5. TECHNICAL DETAILS: Comprehensive information on manufacturing process, raw materials, power, water & fuel etc. are to be furnished. 6. ECONOMICS OF THE PROJECT: Give details of cost of operations, sales and profit etc. as per Annexure III. 7. MANPOWER REQUIREMENT (PER UNIT) S. No. Category Average Salary/P.M. Number(s) Total Cost 1. Managerial 2. Supervisors 3. Skilled 4. Unskilled Total: 8. MARKETING ARRANGEMENTS: Details of market demand, storage facilities and selling tie up etc. made, if any, may be furnished. 9. IMPLEMENTATION SCHEDULE: Sl.No. Activity Commencement Completion Month/Year Month/Year i) Procurement of land ii) Construction of Building/Civil Works. iii) Installation of P&M. iii) Commencement of operations 10. REPAYMENT SCHEDULE: i) Moratorium Period ii) Repayment Period 11. WORKING CAPITAL REQUIREMENT Please give brief justification for the estimate made in the scheme and give details as per Annexure-II. In case working capital is arranged /to be arranged from other source, give the name and address of the Bank/Institution etc. 12. OTHERS: i) Government Consents, if any. ii) Environmental clearance, if any. iii) Other Govt. clearance, if any. iv) List of Assumptions (Please provide list of various assumptions ). NSTFDC FORMAT NO.1 (ANNEXURE-1) TECHNICAL DETAILS (PER UNIT) PART -A BUILDING a) Location b) Own/Leased (Lease Period) c) Rent per month in case of leased/rented d) Construction Cost of New Building/Civil Works (Type of structure, dimensions, area and cost of construction per square feet etc.) PART-B PLANT AND MACHINERY S.NO. Name of Machine& Cost PerUnit No. of Units Total Cost Specifications i) ii) iii) PART-C MISCELLANEOUS FIXED ASSETS Sl.No. Item Cost Per Unit Total Cost i) ii) iii) (ANNEXURE II) DETAILS OF WORKING CAPITAL (PER UNIT) AT FULL CAPACITY UTILISATION S.No. Items Period Qty. Unit Rate Total Amount 1. Raw Materials 2. Stores & Spares 3. Work in process 4. Finished Goods 5. Receivables/Debtors 6. Others (Specify) Total : Less: Credit on purchase Net Working Capital Requirement NSTFDC FORMAT No.1 (ANNEXURE III) COST OF OPERATIONS AND PROFITABILITY STATEMENT (PER UNIT) (Rs. in Lakhs) Sl.No. Particulars Ist year IInd year onwards 1. Installed capacity/ 2. Capacity utilization 3. No. of Working day A. Sales/ Realization/Earnings B. Cost of Operations i) Raw materials ii) Stores & Spares iii) Power & Fuel iv) Repair & maintenance v) Wages & Salaries vi) Administrative and Selling Overheads vii) Interest viii) Depreciation ix) Others (Specify) Total Cost of Operations : C. Gross Profit (A-B) D. Cash Profit E. Profit Before Tax F. Tax G. Profit After Tax Note: Please attach details of assumptions regarding sales realisations /earning etc.
