APPLICATION TO DISTRICT INDUSTRIES CENTRE/REGIONAL JOINT DIRECTOR MADRAS FOR SANCTION OF STATE CAPITAL/SPECIAL CAPITAL (INVESTMENT) SUBSIDY. DEPARTMENT OF INDUSTRIES AND COMMERCE 1. Name of the Applicant and address : i. Registered Office : ii. Factory Address : iii. Phone No. : Office : Factory: 2. i. Constitution (Proprietors/ Partnership/ Corporate Body etc.) : ii. Name of the Director/ Partners : iii. Whether the Proprietors/ Directors/Partners belongs to SC/ST : 3. Location of the unit : Taluk/ Indl. Estate (Village and Taluk) 4. Type of Industry and Project : 5. SSI Registration No. and Date 6. Cost of Project. i. Land ii. Building iii. Plant & Machineries including electrical installations : iv. Other Assets : a. Tools, Jigs, Dice, and Moulds b. Goods, Carriers : c. Transport and erection charges : v. Preliminary and Projected expenses capitalised or to be Capitalised. vi Margin money for Working capital __________ Total __________ 7. Moans of Finance : Rs. in lakhs a. Term Loan : Name of the Institution Amount Date of Sanction. b. c. d. Hire Purchase e. Leasing ____________ Total ____________ 8. Whether all the plant and machinery envisaged in the project are now. If not give list and value of account hold plant and machinery. 9. Employment Men Women Total likely to be created : i. ii. Supervisory/mechanical iii. Workers. a. Skilled : b. Semi skilled : c. Unskilled : --------------------------------------Total -------------------------------------- 10. (a) Expected / retail date of commencement of commercial production of the proposed scheme. (b) If it is an automobile ancillary industry evidence for 50% of production supplied to major Automobile industry. We hereby declare that the Information given above and the statement and other documents enclosed are to the best of our knowledge and belief true and correct. place: AUTHORIZED SIGNATORY Date: DESIGNATION Details of fixed capital Date of purchase Value of purchase STAMP Date of capitalisation of Value as per building/or thereof SIGNATURE OF CHARTERED ACCOUNTANT
