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.
