CONSOLIDATED APPLICATION FORM for – (See rule ... - Nsez.gov.in

Fax No.Permanent E-Mail AddressWeb-Site, if anyPassport No., if anyName of Bank with Address & Account No.Digital SignatureIncome Tax PAN(attach copy)II.Constitution of the applicant firm: Public Limited Company[Tick (√ ) thePrivate Limited Companyappropriate entry]PartnershipProprietor shipOthers (please specify)(Attach copy of Certificate of Incorporation alongwith Articles ofAssociation and Memorandum of Association in case of companies andpartnership deed in case of partnership firms.)III.IV.Nature of the industrial undertaking i. Large scaleii. Medium scale iii.Small scaleName and complete address of eachOf the Directors/Partners/Proprietor, as the casemay be withTelephone numbersV. ITEM (S) OF MANUFACTURE/SERVICEACTIVITY:(Including By-product/Co-products)(If necessary, additional sheets may be attached)Item(s) Description Capacity(Unit = )(Not required for service unit)VI. INVESTMENT: (RS. IN LAKHS)(a)Plant and Machinery(i)(ii)IndigenousImport CIF value(iii) Total (i) + ii)(b)VII.Details of source(s) of financeImport and indigenous requirementof materials and other inputs:(Value in Rupees)ImportIndigenous