Government of Tamil Nadu

Department of Industries and Commerce

Entrepreneurs Memorandum for setting up Micro, Small or Medium Enterprise

Form No.2016/33/012/74692/NHXR
ACKNOWLEDGEMENT PART - I
M/S LAKSHMI STORES HAS FILED MEMORANDUM EXPRESSING ITS INTENT TO SET UP A SEVICES ENTERPRISE AT THE
ADDRESS NO: 07, SRI MAHAGANAPATHIPURAM, KULAMANGALAM POST, MADURAI DISTRICT TAMIL NADU PIN CODE:
625017 FOR THE ITEM/ITEMSINDICATED BELOW AND THE ACTIVITY IS PROPOSED TO COMMENCE FROM SEPT-2016 AS
STATED IN FORM NO 2016/33/012/74692/NHXR AND ALLOCATED ENTREPRENEURS MEMORANDUM NO
2016/33/012/74692/NHXR/E AS BELOW:

Sl.No ITEMS OF MANUFACTURE CAPACITY IN CASE OF MANUFACTURE

1 SERVICES 5 TONS

NOTE: THE ISSUE OF THIS ACKNOWLEDGEMENT DOES NOT BESTOW ANY LEGAL RIGHT. THE ENTERPRISE IS REQUIRED TO SEEK REQUISITE CLEARANCE /
LICENCE / PERMIT REQUIRED UNDER STATUTORY OBLIGATIONS STIPULATED UNDER THE LAWS OF CENTRAL GOVERNMENT / STATE GOVERNMENT / UT
ADMINISTRATION / COURT ORDERS.

DD MM YYYY

DATE OF ISSUE 13 09 2016

NATURE OF ACTIVITY 2 SERVICES

(MANUFACTURING-1, SERVICES-2)

CATEGORY OF THE ENTERPRISE 1 MICRO

(MICRO-1, SMALL-2, MEDIUM-3)

ENTREPRENEURS MEMORANDUM NUMBER E PART

3 3 0 1 2 2 1 74692

DATE: 13/09/2016
PLACE: Madurai

SIGNATURE
(R.Ekambaram)
Additional Director of
Industries & Commerce (DIC)
Note: (1) The concerned Financial Institutions/Agencies who provide Loan/Clearance/Assistance, shall verify this Entrepreneur Memorandum Form Part I in the
website http://www.msmeonline.tn.gov.in, to ascertain the genuineness / validity / cancellation using the above EM PART I Number
(2) The concerned Financial Institution/Agencies who provide Loan/Clearance/Assistance shall ascertain the eligibility of subsidies and incentives
given by the Government, from the General Manager, District Industries Centre, MADURAI.

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 Application Id: 2016/33/012/74692/NHXR
Application Date: 13-09-2016
1.Name of the : LAKSHMI STORES

Applicant 2.
(a) Address of Communication
07, SRI MAHAGANAPATHIPURAM, KULAMANGALAM POST, MADURAI

PIN Code : 625017

Phone : 6369272572
Phone :-
Phone :-

Phone :-

(b) Permanent Residential Address

07, SRI MAHAGANAPATHIPURAM, KULAMANGALAM POST, MADURAI

PIN Code : 625017

Phone : 6369272572
Phone :-
Phone :-
Phone :-

3.Name of The Proposed Enterprise (if decided) : LAKSHMI STORES

4.Proposed Location of Enterprise

(i). S. F. No / Door: 07

(ii). Street. : SRI MAHAGANAPATHIPURAM, KULAMANGALAM POST, MADURAI

(iii). State : Tamil Nadu

(iv). District : Madurai

(v). Taluk : Madurai

(vi). Rural/Urban :Rural
(vii). Block :Madurai
(viii).Town/Village: Madurai

(ix). PIN Code : 625017

5.Category of Enterprise : MICRO

6.Nature of Activity : SERVICES

7.Nature of Operation : Casual

8.Whether Unit will be an Ancillary Unit : No

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9. Proposed Schedule of Installation of : SEPT - 2016
Plant & Machinery
10. Type of Organization : Proprietary
11. (a) Main Manufacturing/Service Activity
No Product/Product Code Item Code Approximate Value
1 SERVICES 28195 5 Tons

12. Proposed Investment In Fixed Assets (Rs in Lakh)

Item Owned/Leased/Rented Approximate Value

(i). Land Leased 10

(ii). Building Leased 10
(iii). Plant & Machinery Value -
(iv). Equipment -
(v). Foreign Equity, If Any -

13. Installed Capacity per annum : 10 TONS

14. Power Load (Anticipated) : H.P : 3.00 K.W : 3.50

15. (a). Other Source of Energy

Item Quantity
(b) Reason if no power required -
16. Expected Employment

(i). Management & Office Staff 1

(ii). Supervisory -
(iii). Workers 2

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17. Expected Schedule of Commencement of
Production/Activity : SEPT - 2016

18. Entrepreneurs Profile

(a). Name : GANESAN K
(b). Gender : MALE (M)

(c). Community: OBC (3)

(d). Knowledge Level: Other Graduate

(e). Equity Participation: 200000
(f). Equity %: 100
(g). Stake in other Manufacturing Enterprises: No
(h). Physically Challenged: No
Date:
Place:

[SIGNATURE OF THE APPLICANT / AUTHORISED PERSON]

NAME OF THE PROPRIETOR/PARTNER/MANAGING DIRECTOR

(a) Send a self-certified copy of this application along with a self-certified copy of Power of Attorney/Board Resolution/Society Resolution wherever applicable,
while signing as Partner/Managing Director or Authorized Person to GENERAL MANAGER , DISTRICT INDUSTRIES CENTRE, Avinashi road, MADURAI.
(b) Send a certificate/notarized copy of the Partnership Deed/Memorandum of association/Articles of Association to General Manager, District Industries
Centre, MADURAI.
(c) In case, self certified copy of the generated application is not received by the General Manager, District Industries Centre, Madurai within one month from the
date of generation of the application, the acknowledgement issued for EM(PART I)will be cancelled and displayed in the website.
(d) In respect of those who furnish wrong information and do manipulations in the online Application Form, penal action will be taken by the Department and
simultaneously the acknowledgement issued for online EM PART I will be automatically cancelled and displayed in the website.

Undertaking
This is to certify that the information furnished in the Memorandum in FORM No: 2016/33/012/74692/NHXR is true and
correct to the best of my knowledge and belief.

Date:
Place:

[SIGNATURE OF THE APPLICANT / AUTHORISED PERSON]

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