PROFORMA APPLICATION FOR DISBURSEMENT UNDER THE INTEREST SUBSIDY FOR SC/ST/WOMEN, INFORMATION TECHNOLOGY / THRUST AREA INDUSTRIAL UNITS 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.
