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Global Opportunities for Indian Industries

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Form-F
 

 

CONSOLIDATED APPLICATION FORM for -
(See rule 17)


1 Setting up of units in Special Economic Zone;
2 Annual permission for sub-contracting;
3 Allotment of Importer Exporter Code Number;
4 Allotment of land/industrial sheds in the Special Economic Zone;
5 Water Connection;
6 Registration-cum-Membership Certificate;
7 Small Scale Industries Registration;
8 Registration with Central Pollution Control Board;
9 Power connection;
10 Building approval plan;
11 Sales Tax registration;
12 Approval from Inspectorate of factories;
13 Pollution control clearance, wherever required;
14 Any other approval as may be required from the State Government
 

The application should be submitted to the Development Commissioner of the concerned Special Economic Zone in 5 copies alongwith a crossed Demand Draft of Rs. 5,000/- drawn in favour of the Pay & Accounts Officer, of the concerned Special Economic Zone together with a project report giving details of activities proposed.


For Official use only


Application No.  
Date
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  Date   Month  

Year

           
Details of Bank Draft

Amount Rs. ____________________
Draft No. ____________________
Draft Date ____________________
Drawn on (Name of the Bank) ____________________
Payable at ____________________
   


PART – I


I. Name and full address of applicant firm/company  (in block letters)
Name of the applicant Firm/company ____________________
Full Address
(Regd. Office in case of Limited Companies & Head Office for others)
____________________
Pin Code ____________________
Tel.No. ____________________
Fax No. ____________________
Permanent E-mail Address ____________________
Web-Site, if any ____________________
Passport No., if any ____________________
Name of Bank with Address & a/c No. ____________________
Income Tax PAN (attach copy)
____________________
   
II. Constitution of the applicant firm: (Please click/tick the appropriate entry)
Government Undertaking   [   ]
Public Limited Company   [   ]
Private Limited Company   [   ]
Proprietorship   [   ]
Partnership   [   ]
Others (Please Specify)   [   ]
(Attach copy of the certificate of incorporation alongwith Article of Association and Memorandum in case of companies and Partnership deed in case of partnership firms)
 

III. Nature of the industrial undertaking: (Please click/tick the appropriate entry)
  i.   Large Scale ____________________
  ii.  Medium Scale ____________________
  iii. Small Scale ____________________
     
IV Name and complete address of each of the Directors/partners/ Proprietor, as the case may be with telephone No.
Sl.No.

Name

Address

Telephone No.

1.

____________________
____________________
____________________
2.
____________________
____________________
____________________
3.
____________________
____________________
____________________
4.
____________________
____________________
____________________
5.
____________________
____________________
____________________
6.
____________________
____________________
____________________
       
   
V. ITEM(S) OF MANUFACTURE/SERVICE: (Including By-product/Co-products)

(If necessary, additional sheets may be attached)

Item(s) Description

Capacity (Unit = [  ] )

Item Code (ITC HD Code No.)

(Note required for service unit)

____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
____________________
     
   
VI. INVESTMENT
 

Rs. In lakhs

US $ thousand

a) Plant and machinery

____________________
  i)        Indigenous

____________________
  ii)       Imported (CIF Value )  
____________________
  (iii)     Total (i)+(ii)  
____________________
b) Details of source(s) of finance  
____________________
       
VII. Import and indigenous requirement of materials and other inputs (Value in Rupees lakhs)
 

Import

Indigenous

a) Capital goods
____________________
____________________
b) Raw material, components, consumables, packing material, fuel etc for 5 years
____________________
____________________
Total
____________________
____________________
(Give details in project report, namely list of capital goods, description of raw materials, and other inputs, etc)
 
VIII INFRASTRUCTURE REQUIREMENTS
  Requirement of Land:- (Area in sq. mtrs.)
1. i.   Factory & Officers
____________________
ii. Warehousing/storage
____________________
iii. Others, specify
____________________
2. Requirement of built-up area
____________________
3. Requirement of Water

(In Kilo Litres)

i. For industrial (process purposes
____________________
ii. For drinking purposes
____________________
iii. Others, specify
____________________
iv. Total requirement
____________________
4. Effluent Treatment  
i. Quantum and nature of effluents and mode of disposal
____________________
ii. Specify whether own Effluent Treatment Plant will be created
____________________
5. Requirement of Power (in KVA)
____________________
       
IX Employment

Men

Women
   
       
X WHETHER FOREIGN TECHNOLOGY AGREEMENT IS ENVISAGED

(Tick the appropriate Entry)
  Yes   [  ]   No  [  ]
(i) Name and Full Address of foreign collaborator ____________________
(ii) Nature of collaboration ____________________
1. Equity participation including Investment
 

($ in thousand)

(Rs. In lakhs)

i) a) Authorised ____________________ ____________________
  b) Subscribed ____________________ ____________________
  c) Paid up capital    
  Note: If it is an existing company, give the break up of existing and proposed capital structure
ii) Pattern of share holding in the paid-up capital
   

(Rs. In lakjs)

(US $ Thousand)

  a)  Foreign Holding ____________________ ____________________
  b) Non Resident Indian company/Individual holding
            i) Repatriable ____________________ ____________________
            ii) Non-repatriable ____________________ ____________________
  c)  Resident Holding ____________________ ____________________
  d)  Total Equity ____________________ ____________________
  e)  External Commercial Borrowing
(Give details)
____________________ ____________________
2. Technical Collaboration (Furnish details in project report
   

(Gross of taxes – Rs. In lakhs)

  a) Lumpsum payment ____________________
  b) Design & Drawing Fee ____________________
  c) Payment to foreign technician ____________________
  d) Royalty (on exports) ____________________ %
  e) Royalty (On domestic tariff Area if envisaged) ____________________
  f) Duration of agreement ____________________ Years
3. Marketing Collaboration

(Furnish details in project report)
 
     
XI. FOREIGN EXCHANGE BALANCE SHEET


  1st Year 2nd Year 3rd Year 4th Year 5th Year

Total

Rs. Lakhs US$ Thous.
1. FOB Value of exports in first five years   [  ]   [  ]   [  ]   [  ]   [  ]   [  ]   [  ]
2. *Foreign Exchange outgo for the first five years   [  ]   [  ]   [  ]   [  ]   [  ]   [  ]   [  ]
3. Net Foreign Exchange Earnings for the first five years (1-2)   [  ]   [  ]   [  ]   [  ]   [  ]   [  ]   [  ]
                 


* Foreign exchange outgo shall include the CIF value of import of machinery, raw –material, components, consumables, spares, packing materials and amount of repatriation of dividends and profits, royalty, lump sum know-how fee, design and drawing fee, payment of foreign technicians, payment on training of India technicians abroad, commission on export, interest on external commercial borrowings, interest on deferred payment credit and any other payments.


XII. OTHER INFORMATION
(i) Whether the applicant has been issued any Industrial license or LOI/LOP under EOU/SEZ/STP/ EHTP scheme.  If so, please give full particulars especially reference number, date of issue, items of manufacture and progress of implementation of each project ____________________
(ii) Whether the applicant or any of the partners/Directors who are also partners/Directors of another company or its associate concerns are being proceeded against or have been debarred from getting any Lincese/letter of Intent/Letter of Permission under the Export and Import (Control) Act, 1947/Foreign Trade (Development and Regulation) Act, 1992/FEMA/Custos/Central Excise Act. ____________________
     
Place ____________________ Signature of the applicant  
Date ____________________ Name in Block Letters ____________________
Official Seal/ Stamp ____________________ Designation ____________________
Tel No. ____________________
E-Mail address ____________________
Website, if any ____________________
Full Residential Address ____________________
       

UNDERTAKING



I/We hereby declare that the above statements are true and correct to the best of my/our knowledge and belief.  I/We will abide by any other condition, which may be stipulated by the concerned Development Commissioner.  I/We fully understand that any Permission Letter granted to me/us on the basis of the statement furnished is liable to cancellation or any other action that may be taken having regard to the circumstances of the case if it is found that any of the statements or facts therein are incorrect or false.  An affidavit duly sworn in support of the above information is enclosed.


Place ____________________ Signature of the applicant  
Date ____________________ Name in Block Letters ____________________
Official Seal/ Stamp   Designation ____________________
Tel No. ____________________
E-Mail address ____________________
Website, if any ____________________
Full Residential Address ____________________
       
Note: Format of application not given herein may be obtained from the Development Commissioner.


PART II



If sub-contracting is envisaged in the manufacturing operations, furnish following details:-

i.

Sub-contracting permission is required for
a) Part of the production process ____________________
b) Any particular production process (Give Details) ____________________

ii.

Name and address and other particulars of sub-contractor and whether the sub-contractor is ____________________
  a) Domestic Tariff Area unit/Central Excise registered or otherwise ____________________
  b) Other Special Economic Zone unit ____________________
  c) Export oriented unit or Electronic Hardware Technology Park unit or Software Technology Park Unit ____________________
       

 
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