NAME and ADDRESS OF APPLICANT'S PLANT : ___________________________________

STATEMENT OF PLANT AND MACHINERY INSTALLED FOR * "NEW INDUSTRIES" /

"ADDITIONAL UNIT OF THE EXISTING INDUSTRIAL UNDERTAKING" AS ON DATE OF
PRODUCTION i.e. Dt. _________

PURCHASE PERIOD : FROM __________TO __________ .

SR. NAME AND DESCRIPTION OF BILL NEW OR DATE OF
NO. ADDRESS OF MACHINERY NO. DATE AMOUNT# OLD@ INSTALLATION
SUPPLIER (RS.) MACHINE

1 2 3 4 5 6 7 8

TOTAL …>>>
* strike out which is not applicable.
# If investment amount is other than bill amount than same should be shown in separate column.
@ old = previously used for production purpose by any one any where in India.

Signature with Stamp of Applicant

/fmt22a_Dec2015 – P and M Statement