PROFORMA APPLICATION FOR DISBURSEMENT UNDER THE 20 PER CENT CAPITAL INVESTMENT SUBSIDY SCHEME FOR INFORMATION TECHNOLOGY INDUSTRIAL UNITS 1 Name of the applicant 2 Address for communication Phone Fax e-mail 3 Name & address of the Industry Phone Fax e-mail 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 Whether the project for the new unit /expansion of the unit has been approved by the following financial institutions /Banks viz. 1. 2. 3. 4. Yes /No 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 Whether certificate from the financial institution / bank is enclosed Yes /No 9 Plant and Machinery Sl. No Details of the machinery Name & Address of the supplier Invoice/ bill No. & date Value When installed Subsidy Amount Claimed 10 Performance of the Unit Year Investment Employment Generated Export turnover Domestic turnover Total turnover 11 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) A Certificate from chartered accountant M/s .......certifying the extent of share capital subscribed and paid up value of fixed assets, if any, acquired and paid for as stated above. (b) 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 20 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 cent 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 other Department/ Agency of Government of Pondicherry I/We hereby agree that I/we shall not shift the machinery /Unit for a period of five years from the date of areement. 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 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:
