DIRECTORATE OF INDUSTRIES

Package Scheme of Incentives-200

PROFOR!A OF FOR!- I
S"#
No
Desc"i$tion
1. Application Number % (for office use)
2. Date of Receipt % (for office use)
3. Name of Applicant / Industrial Unit %
4. ffice Address
a. Re!istered ffice Address %
Address %
"it# %
$in %
b. %elep&one No. %
c. '(mail %
). a. *ead ffice Address
Address %
"it# %
$in %
b. %elep&one No. %
c. '(mail %
+. ,actor# Address
a. District %
b. %alu-a %
c. $ost %
d. .illa!e %
e. '/tra address line %
f. '/tra address line %
0. "onstitution
a. Aut&orit# of "ertification %
b. 1etter /Ac-. No. of Incorporation %
c. Date of 'stablis&ment %
2. Name 3 Address of $rop./$artners 4 4
a. Name %
b. Residential Address 5 16 %
Address 5 26 %
Address 5 36 %
c. %elep&one No.3 '(mail %
7.(I) Details of $re8ious Appln.9 if an# %
a. Date of Application %
b. Date of filin! %
c. :c&eme %
d. Date9 if application ;it&dra;al from
pre8ious sc&eme.
%
(II) Details of 1I under earlier sc&eme
a. 1etter of Intent<s No. %
b. Date of Issue %
c. :c&eme %
(III) Details of '.". ($art I)
a. ,i/ed "apital In8estment
(in lacs)
b. $roduct/s
c. 1ocation
d. '.". Number
e. '.". issue date
f. .alidit# from
!. .alidit# upto
&. :c&eme
%
%
%
%
%
%
%
%
(I.) Details of '.". (as per :.%.) $art II
a. ,i/ed "apital In8estment
(in lacs)
b. $roduct/s
c. 1ocation
d. '.". Number
e. '.". issue date
f. .alidit# from
!. .alidit# upto
&. :c&eme
i . :.%. 1oan 'ntitlement
%
%
%
%
%
%
%
%
%
%
1= 'ffecti8e steps ta-en / completed (1and) 4 4
a. $lot / 1and t#pe
b. $lot No.
c. $lot Area
d. >ala No
e. $ossession of land
f. Is it !ro;t& center (?/N)
%
%
%
%
%
%
11 %#pe of Industr#
a. Is it case of s&iftin! unit @ (?/N) %
12 Details of Re!istrations9 1icences 4 4
a. Re!istration Aut&orit# %
b. Date of Re!istration
c. Re!n./1icence/ Ac-no;led!ement No.
%
%
13. $roduct for ;&ic& Re!n. btained 4 4
a. $roduct "ode
b. $roduct Details
c. $roposed "apacit#
d. Unit of $roduction
e. '/pected date of production
f. Date of commencement of production.
!. '/pected turno8er in lacs.
%
%
%
%
%
%
%
14. An# scrap if unit releases
a. :crap details
b. .alue of scrap
%
%
1). An# b# product9 unit ma-es
a. A# product name
b. A# product 8alue
%
%
1+ "onsents 3 $ermissions 4 4
a. Aut&orit#
b. Date of clearance
%
%
10. Accountin! #ear 3 e/penditure
a. Accountin! #ear follo;ed.
b. "ost and date of fi/ed assets acBuired b#
unit.
c. Ad8ance paid to supplier to;ards capital cost
and date.
%
%
%
12 Re!istration under t&e
a. :ales %a/ Act.
b. Re!istration No.
c. Date of Re!istration.
d. Date of effect.
%
%
%
%
17. Re!istration details in case of transferr# !i8e
re!istration of transferor.
a. Re!istration :ales %a/ Act.
b. Re!istration Number
c. Date of Re!istration
%
%
%
d. Date of 'ffect.
e. C&et&er permission to t&e file consolidated
returns obtained @
f. rder No. of permission.
!. Date of order issued.
%
%
%
%
2=. $roDect cost as per applicant. (Rs. in lacs)
a. 1and
b. Auildin! (ffice E ,actor# E Admn. E Resi.
Fuarters E Indl. *ousin! accom. etc.)
c. $lant 3 Gac&iner#.
d. %ec&. Hno;(&o; fees/ en!ineerin! etc.
e. t&er Assets.
f. $reliminar# 3 "apital issue e/penses.
!. $re operati8e e/penses
&. $ro8ision for contin!encies.
i. Gar!in for ;or-in! capital
D. %%A1
%
%
%
%
%
%
%
%
%
%
21. $roDect cost as per appraisal note
a. 1and
b. Auildin! (ffice E ,actor# E Admn. E Resi.
Fuarters E Indl. *ousin! accom. etc.)
c. $lant 3 Gac&iner#.
d. %ec&. Hno;(&o; fees/ en!ineerin! etc.
e. t&er Assets.
f. $reliminar# 3 "apital issue e/penses.
!. $re operati8e e/penses
&. $ro8ision for contin!encies.
i. Gar!in for ;or-in! capital
D. %%A1
%
%
%
%
%
%
%
%
%
%
22 Geans of finance 4 4
a. Geans
b. :ource
c. Amount in Rs.(lacs)
%
%
%
23 'stimated ;ater suppl# 4 4
a. :ource %
b. :uppl# (;it& unit) %
24. 'stimated electric po;er re!. 4 4
a. :ource
b. :uppl# (;it& unit)
%
%
2). A8era!e ;or-ers proposed to be emplo#ed at t&e
time of commencement of production.
a. Gale super8isor# cadre
b. ,emale super8isor# cadre
c. Gale ;or-er cadre.
d. ,emale ;or-er cadre.
e. I of local emplo#ment
(:upr. "adre)
f. I of local emplo#ment.
(;or-er cadre)
%
%
%
%
%
%
%
2+ 1ist of enclosures ;it& application. 4 4 %
NOTE %-
1. & ' ' ( indicated for multiple information so list ma# be enclosed.
2. "ertified t&at no letter of intent or 'li!ibilit# "ertificate for an# of t&e proDects/ t&e proDect /
unit aforesaid &as been in column no. ) and t&at t&is is t&e first application in re!ard to t&e
proDect / unit aforesaid.
3. "ertified t&at t&e information / statement contained in t&is application for eli!ibilit#
certificate are true to t&e best of m# / our -no;led!e.
4. Declared t&at no >o8ernment enBuir# &as been instituted a!ainst t&e applicant and / or its
$roprietor / $artners/ Directors for an# economic offence.
). Ce &ereb# a!ree to abide b# t&e terms and conditions of t&e letter of intent / 'li!ibilit#
"ertificate to be issued. In pursuance of t&e abo8e application for 'li!ibilit# "ertificate.
+. Ce &ereb# a!ree t&at t&e letter of Intent / 'li!ibilit# "ertificate / "ertificate of entitlement
issued on t&e basis of t&e abo8e statements made and information furnis&ed eit&er
alon!;it& t&is application or &ereafter in connection ;it& t&e abo8e matter is liable to be
canceled ab(initio or rendered in8alid or ;it&dra;n if an# of t&e statements and / or
information is / are found to incorrect / untrue. All t&e momentar# benefits alread# a8ailed
of on t&e basis of t&e 'li!ibilit# "ertificate so cancelled s&all be reco8erable as >o8ernment
dues fort&;it& alon!;it& compound interest at J 22 I per annum or at suc& ot&er &i!&er
rate as ma# be fi/ed b# t&e Implementin! A!enc# from time to time and no furt&er benefits
;ill be a8ailable to t&e proDect unit for ;&ic& t&e abo8e application is made.
:i!nature of t&e applicant
$roprietor / $artner / Director / %rustee
$lace K (%&is application s&all be si!ned onl# b# an# one
of t&e persons indicated abo8e ;it& appropriate
rubber stamps of t&e applicant and desi!nation of
t&e si!nator#)
Date K(
/8ar/;;;/apps/con8ersion/tmp/scratc&L3/23++24)24.doc
Doc)ments "e*)i"e+ )n+e" PSI 200,
-Ne. / e0$ansion1
A2 Initia3 Effective Ste$s-
,2 Effective $ossession of 3an+%
i1 !IDC $ossession "ecei$t .ith ag"eement OR
ii1 Registe"e+ 3an+ $)"chase +oc)ments .ith /,2 e0t"acts / In+e0 II OR
iii1 Registe"e+ 3ease +ee+ fo" 3ease 3an+ / $"emises -at 3east of ,4 5ea"s1
iv1 Fo" 3an+ o)tsi+e !IDC a"ea NOC f"om 6"am$ancha5at o" in case the
)nit is 3ocate+ .ithin an a"ea cove"e+ )n+e" a +"aft o" fina3 Regiona3
Deve3o$ment P3ant a$$"ove+ 75 6ovt#8 9one confi"ming 3ette" f"om
com$etent a)tho"it5#
NOTE%
i1 In case of $"o$"ieta"5 )nit the 3an+ can 7e $e"mitte+ in the name of
P"o$"ieto" an+ in othe" cases it sho)3+ 7e in the name of fi"m#
ii1 The 3an+ o)tsi+e !IDC a"ea .i33 "e*)i"e N#A# $e"mission fo"
in+)st"ia3 )se o" 9oning ce"tificate f"om the com$etent a)tho"it5 -As
$e" 6#R# +ate+ 2:#:#20001
22 Constit)tion%
P"o$"ieta"5/Pa"tne"shi$/P"ivate o" P)73ic ;imite+ Com$an5/
Co-o$e"ative Societ5/ T")st#
i1 Regist"ation in "es$ect of fi"m / Com$an5/ Societ5 an+ Co-o$e"ative
Societ5 -.ith the co$5 of <5e-;a.s1 / T")st -+e$en+ing on
constit)tion1
ii1 In case of Pa"tne"shi$ fi"m evi+ence of e0ec)tion of $a"tne"shi$
+ee+ an+ fi3ing the "e*)isite a$$3ication .ith $a5ment "ecei$t of
necessa"5 "egist"ation fees .ith the Regist"a" of Fi"m#
:2 Regist"ation%
i1 P"ovisiona3 SSI/;OI o" "egist"ation fo" IT )nits f"om Di"ecto"ate of
In+)st"ies o" SICO! / ;OI f"om 6ovt# of In+ia
ii1 Photoco$5 of IE! a3ong.ith a co$5 of ackno.3e+gement#
/8ar/;;;/apps/con8ersion/tmp/scratc&L3/23++24)24.doc