TAMILNADU SMALL INDUSTRIES DEVELOPMENT CORPORATION LTD., (A Govt. of Tamilnadu Enterprise) Paulwels Road, Kathipara Junction, Chennai - 16. MARKETING ASSISTANCE SCHEME REGISTRATION FORM Note: Application in duplicate should be filed along with a Demand Draft for Rs.200/- drawn in favour of "Tamil Nadu Small Industries Development Corporation Limited" (TANSIDCO) towards Registration Fee, which is a non-refundable one. 1) a) Name and Office Address of the Small : Scale Unit with Phone No., Fax No. & E-Mail address b) Address of the Factory premises with : Phone No., Fax No. & E-Mail address c) Whether Proprietory / Partnership / Public : Limited / Private Ltd., (Attested copy of Partnership Deed / Memorandum & Articles of Association should be furnished 2) Name of the Proprietor /Managing Partner / : Managing Director 3) Date of Commencement of regular production : 4) SSI Registration Number with validity : (attested copy of permanent SSI Certificate to be furnished) 5) Line of activity as per permanent SSI : Certificate 6) a) Products actually manufactured (give : details of manufacturing operations involved in a separate sheet) b) Capacity for production of each product : c) Brand Name(s), if any : 7) Products for which unit desires to be : registered with TANSIDCO 8) Number of employees Managerial Supervisory Technical : : : Non-technical : Others : ________________ Total Employment : ________________ 9) Capital Investment a) Fixed Assets i) Land & Building ii) Plant & Machinery :Rs. :Rs. ________________ iii) Working Capital :Rs. Total ________________ Rs. 10) Factory Area 11) Electric Power sanctioned / installed (in HP) ________________ :Covered area : Open area :: sq.ft. sq.ft. 12) Details of equipment and machinery installed with particular mention about any special feature of the machine with reference to accuracy etc. : 13) Banker's name & address : 14) Annual Sales Turnover of each item mentioned in Col.7 for the past two years 15) Details of previous supply to Govt. Departments / Quasi Govt. Depts./Local Bodies etc., for the past two years. i. Name of Govt. Dept /Quasi Govt. Department ii. Full description of Articles Supplied Iii. Value (Rs. in lakhs) : : : 16) Details of clients in the private sector : 17) Details of products exported for the past two years : a. Name of the product exported : b. Value (Rs. in lakhs) ; c. Name of the country to which exported : 18) Whether enrolled under a) ISI Mark / ISO 9000 etc. : b) State or Central Govt. Testing Scheme : c) DGS & D Registration : d) NSIC Regn. : e) Export Promotion Councils : (if so, details of such registration along with : xerox copies of registration certificates to be furnished) 19) Whether the unit received any awards for : performance / quality etc. if so, details to be furnished along with evidences. 20) Whether registered under TNGST / CST; if so, : Regn.No. & date (xerox copies of certificates to be furnished) 21) Has the unit got a laboratory and system of : testing the products before delivery. If so, details thereof 22) Percentage of Actual product cost with split up details on i) Direct cost of raw materials : ii) Direct cost of Labour : iii) Overheads : 23) Margin of Profit : 24) Specify the sales tax, surcharge on sales tax : applicable for the product(s) 25) Net price including F.O.R. destination any where in Tamilnadu for quantity by weight or volume, (nature of packing to be specified). Certified that all the particulars furnished above are true to the best of our knowledge. Signature of the unitholder with Company Seal & Date
