PROFORMA APPLICATION FOR CLAIM FOR THE GRANT OF 25%SPEICAL INVESTMENT SUBSIDY FOR INDUSTRIAL UNITS STARTED BY SC/ST & WOMEN ENTREPRENEURS. 1 Name of the applicant 2 Address for communication 3 Name & address of the Industry 4 Whether sole proprietorship/ Partnership/ Pvt. Ltd./ Public Ltd. 5 Name of the products manufactured (Approved) 6 Date of commencement of production (copy of SSI PMT registration certificate to be enclosed) 7 The Scheme for the new unit /expansion of the unit has been approved by the following financial institutions /Banks viz. 1. 2. 3. 4. 8 The cost of the project approved by the above institution /bank and the details of fixed assets acquired are as under Item Cost of the Project (Rs.) Self Financed Financial Institution Total fixed capital investment Land Building Plant and Machinery Other assets Tools, Jigs and moulds Goods Carriers Other assets Promotional and pre-operative expenses capitalised or to be capitalised. Working capital 9 Employment proposed or likely to be created is as follows:-Managerial Supervisory/Technical Workers Skilled Semi-skilled Unskilled Others The following certificates have been appended: A Certificate from chartered accountant certifying the extent of share capital subscribed and paid up value of fixed assets, if any, acquired and paid for as stated above. Caste certificate from competent authority in case of SC/ST entrepreneurs. A copy of the latest audited accounts of the unit is also enclosed herewith. I/We hereby agree that, I/We shall forthwith repay the amount disbursed to me/us under this scheme, if the amount of 25 percent investment subsidy is found to have been disbursed in excess of the amount actually admissible for whatsoever reason. Further, I/We shall also be liable to pay interest at such rate as prescribed by Government from time to time on such amount and such other charges/expenses which may be payable by me/us. It is hereby further certified that I/we have not hitherto applied for or have received any amount by way of grant or subsidy in respect of this unit from any State Government I/We hereby agree that I/We shall forthwith refund fully with interest in case the new partners or shareholders or Board of Directors other than SC/ST & Women are included in the business within five years from the date of availing the subsidy. I/We hereby agree that I/we shall not shift the machinery /Unit for a period of five years from the date of availing subsidy. In the event shifting I/we agree to pay the subsidy amount along with penal interest at such rate as may be prescribed by the Govt. from time to time. Signature of the applicant. Name of the Signatory. For and on behalf of (Name of the unit) ANNEXURE - I (Certificate from the concerned financial institution/bank in the following form duly signed by responsible officer) Certified that M/s...................have been disbursed on this date loan amounting to Rs..... sanctioned under letter No......... Dated...... as shown below: Rs. 1 Loan amount previously disbursed upto Present installment disbursed on 2 Total amount disbursed upto date 3 Value of fixed capital investment Land (Excluding house-hold) Building (Excluding residential quarters) Plant & machinery (including (a) Expenses regarding technical know-how; (b) Engineering fees; (c) Cost of feasibility study; (d) Promotional and preoperative expenses capitalised). Other assets, Tools, Jigs, Dies and Moulds: and Goods Carriers. Total Certified that the sanction of financial assistance to M/s.............. for the plant at ............ has been considered on the basis of the company's assessed requirements of civil works and buildings, as shown below: Value (Rs.) Proposed building for factory The above value is considered as reasonable and in need for the plant. Signature of the Agent or Manager ANNEXURE -II Details of fixed capital investment (A) LAND: Date of purchase Value of purchase (1) (2) (B). BUILDING: Date of completion of Value as per Engineer's Amount spent on building building or part there of certificate upto (1) (2) (3) (C). PLANT & MANCHINERY: Sl.No (1) Details of machineries (2) Name & Address of the supplier (3) Invoice/bill No. & date (4) Value (Rs) (5) When installed (6) Signature of the applicant Seal: Place: Date: ANNEXURE-III ENGINEER'S CERTIFICATE (to be certified by the PWD/PIPDIC civil engineers) I hereby certify that as against the estimated cost of Rs.............. (Rupees.................... only) of the building and civil works for M/s.............. for their proposed project at............. The unit has so far completed the civil works as under: 1. Value of completed civil works as per the estimates :Rs. 2. Value of the materials at site :Rs. 3. Amount certified for payment to the building :Rs. (Civil and structural Contractors). 4. Retention Money (from civil Contractors) Signature of the Engineer. Place: Date: ANNEXURE-IV We hereby certify that........................( Name of the Industries unit) have acquired the following machineries for their unit at ........ .................................. (Address) for the manufacture of ......................... (Name of the product) by the Industrial unit. Sl.No. Name of the item Date of From whom Value Paid Remarks & Manufacturing Capacity Purchase Purchased for (1) (2) (3) (4) (5) (6) We have checked the machineries and the invoices, etc., and certify the value of the machineries to be true. Signature of the Engineer. Place: Date: ANNEXURE-V Name of the Chartered Accountant(s): We hereby certify that........................( Name of the Industrial unit) have acquired the following machinery for their unit at ........ .................................. (Address) for the manufacture of ......................... (Name of the product) by the Industrial unit. Item of fixed assets Value (Rs) 1 Lease hold/free hold land 2 Cost of development of the land 3 Building under construction:: (a) Amount paid to the building contractors (b) Amount paid to for building materials (c) Amount paid for wages and salaries etc. for the building construction Architect's fee 4 Electrical Installation 5 Plant and Machinery. a) Value paid for items at site (break up details to be furnished separately). b) Advance payments to machinery suppliers (break up details to be furnished separately). 6 Loading, unloading, transportation, octroi duties, Erection expenses etc. 7 Pre-operative expenses to be capitalised 8 Preliminary expenses to be capitalised 9 Miscellaneous fixed assets (a) (b) We have checked the books of accounts of the unit, the invoices etc., and certify that the aforesaid information furnished above has been verified and found to be true. We also certify that all the aforesaid items have been paid and no credit is raised there against in the books of the unit. CHARTERED ACCOUNTANTS Place: Date: PROFORMA APPLICATION FOR DISBURSEMENT UNDER THE RENT SUBSIDY SCHEME FOR INDUSTRIAL UNITS STARTED BY SC/ST & WOMEN ENTREPRENEURS 1 Name of the applicant 2 Address for communication 3 Name & address of the Industry 4 Whether sole proprietorship/ Partnership/ Pvt. Ltd./ Public Ltd. 5 Name of the products manufactured (Approved) 6 Date of commencement of production (copy of SSI PMT registration certificate to be enclosed) 7 Total area of land Sq.Mts 8 Rent per month (for units located outside the Industrial estate copy of lease deed and Rent reasonable certificate obtained from PWD (Rent fixation statement to be enclosed) 9 Period for which the subsidy is claimed Period Amount paid AFFIDAVIT The particulars furnished above are true and I hereby undertake to refund the entire subsidy with interest if any false claim is found subsequently. Signature of the applicant Place: Date: Note:-In the case of SC/ST entrepreneurs, caste certificate from the competent authority shall be attached while making the initial claim by the individual/Parties concerned. PROFORMA APPLICATION FOR DISBURSEMENT UNDER THE INTEREST SUBSIDY FOR INDUSTRIAL UNITS STARTED BY SC/ST & WOMEN ENTREPRENEURS 1 Name of the applicant 2 Address for communication 3 Name & address of the Industry 4 Whether sole proprietorship/ Partnership/ Pvt. Ltd./ Public Ltd. 5 Name of the products manufactured (Approved) 6 Date of commencement of production (copy of SSI PMT registration certificate to be enclosed) 7 Name of Financial Institution/ Bank which have financed the project (copy of the sanction letter to be enclosed). 8 The cost of the project as approved by the above Institution/ Bank and details of fixed assets acquired and working capital Item Amount Total fixed capital investment Land Building Plant and Machinery Other assets Tools, Jigs and moulds Goods Carriers Other assets Promotional and pre-operative expenses capitalised or to be capitalised. Working capital 9 Details of Loan availed from financial Institution/Bank. (Sanction copy to be enclosed). 10 Rate of interest charged by the financial institution and bank (Copy to be enclosed) 11 Period for which the subsidy to be Claimed. Period Amount Paid (No due Certificate from the Financial institution/bank should be enclosed) AFFIDAVIT The particulars furnished above are true and I hereby undertake to refund the entire subsidy with interest if any false claim is found subsequently. Signature of the applicant Place: Date: Note:-In the case of SC/ST entrepreneurs, caste certificate from the competent authority shall be attached while making the initial claim by the individual/Parties concerned.
