PROFORMA

APPLICATION FOR CLAIM FOR THE GRANT OF 25%SPEICAL INVESTMENT SUBSIDY FOR INDUSTRIAL UNITS STARTED BY SC/ST & WOMEN ENTREPRENEURS.

1 / Name of the applicant
2 / Address for communication
3 / Name & address of the Industry
4 / Whether sole proprietorship/ Partnership/ Pvt. Ltd./ Public Ltd.
5 / Name of the products manufactured (Approved)
6 / Date of commencement of production (copy of SSI PMT registration certificate to be enclosed)
7 / The Scheme for the new unit /expansion of the unit has been approved by the following financial institutions /Banks viz.
1.
2.
3.
4.
8 / The cost of the project approved by the above institution /bank and the details of fixed assets acquired are as under
Item / Cost of the Project
(Rs.)
Self Financed / Financial Institution
Total fixed capital investment
Land
Building
Plant and Machinery
Other assets
Tools, Jigs and moulds
Goods Carriers
Other assets
Promotional and pre-operative expenses
capitalised or to be capitalised.
Working capital
9 / Employment proposed or likely to be created is as follows:-
Managerial
Supervisory/Technical
Workers
Skilled
Semi-skilled
Unskilled
Others

The following certificates have been appended:

A Certificate from chartered accountant certifying the extent of share capital subscribed and paid up value of fixed assets, if any, acquired and paid for as stated above.

Caste certificate from competent authority in case of SC/ST entrepreneurs.

A copy of the latest audited accounts of the unit is also enclosed herewith.

I/We hereby agree that, I/We shall forthwith repay the amount disbursed to me/us under this scheme, if the amount of 25 percent investment subsidy is found to have been disbursed in excess of the amount actually admissible for whatsoever reason. Further, I/We shall also be liable to pay interest at such rate as prescribed by Government from time to time on such amount and such other charges/expenses which may be payable by me/us.

It is hereby further certified that I/we have not hitherto applied for or have received any amount by way of grant or subsidy in respect of this unit from any State Government

I/We hereby agree that I/We shall forthwith refund fully with interest in case the new partners or shareholders or Board of Directors other than SC/ST & Women are included in the business within five years from the date of availing the subsidy.

I/We hereby agree that I/we shall not shift the machinery /Unit for a period of five years from the date of availing subsidy. In the event shifting I/we agree to pay the subsidy amount along with penal interest at such rate as may be prescribed by the Govt. from time to time.

Signature of the applicant.

Name of the Signatory.

For and on behalf of (Name of the unit)

ANNEXURE – I

(Certificate from the concerned financial institution/bank in the following form duly signed by responsible officer)

Certified that M/s…………………………………………………have been disbursed on this date loan amounting to Rs…………… sanctioned under letter No………………………

Dated……………… as shown below:

Rs.

1 / Loan amount previously disbursed upto
Present installment disbursed on
2 / Total amount disbursed upto date
3 / Value of fixed capital investment
Land (Excluding house-hold)
Building (Excluding residential quarters)
Plant & machinery (including (a) Expenses regarding technical know-how; (b) Engineering fees; (c) Cost of feasibility study; (d) Promotional and pre-operative expenses capitalised).
Other assets, Tools, Jigs, Dies and Moulds: and Goods Carriers.
Total

Certified that the sanction of financial assistance to M/s…………………………………… for the plant at ………………………….. has been considered on the basis of the company’s assessed requirements of civil works and buildings, as shown below:

Value (Rs.)

Proposed building for factory

The above value is considered as reasonable and in need for the plant.

Signature of the Agent or Manager

ANNEXURE –II

DETAILS OF FIXED CAPITAL INVESTMENT

(A)LAND:

Date of purchase
(1) / Value of purchase
(2)

(B). BUILDING:

Date of completion of building or part there of
(1) / Value as per Engineer’s certificate
(2) / Amount spent on building upto
(3)

(C). PLANT & MANCHINERY:

Sl.No / Details of machineries / Name & Address of the supplier / Invoice/bill No. & date / Value
(Rs) / When installed
(1) / (2) / (3) / (4) / (5) / (6)

Signature of the applicant

Seal:

Place:

Date:

ANNEXURE-III

[See para IV (vii) (b)]

ENGINEER’S CERTIFICATE

(to be certified by the PWD/PIPDIC civil engineers)

I hereby certify that as against the estimated cost of Rs……………………………………

(Rupees……………………………………………….. only) of the building and civil works for M/s……………………………….. for their proposed project at…………………………………

The unit has so far completed the civil works as under:

1.Value of completed civil works as per the estimates:Rs.

2.Value of the materials at site:Rs.

3.Amount certified for payment to the building:Rs.

(Civil and structural Contractors).

  1. Retention Money (from civil Contractors)

Signature of the Engineer.

Place:

Date:

ANNEXURE-IV

[See para IV (vii)(e)]

We hereby certify that………………………………………………………………( Name of the Industries unit) have acquired the following machineries for their unit at …………………. …………………………………………………………………………………….. (Address) for the manufacture of …………………………………………………………….. (Name of the product) by the Industrial unit.

Sl.No. / Name of the item & Manufacturing Capacity / Date of Purchase / From whom Purchased / Value Paid for / Remarks
(1) / (2) / (3) / (4) / (5) / (6)

We have checked the machinery and the invoices, etc., and certify the value of the machinery to be true.

Signature of the Engineer.

Place:

Date:

ANNEXURE-V

Name of the Chartered Accountant(s):

We hereby certify that………………………………………………………………( Name of the Industrial unit) have acquired the following machinery for their unit at …………………. …………………………………………………………………………………….. (Address) for the manufacture of …………………………………………………………….. (Name of the product) by the Industrial unit.

Item of fixed assets / Value (Rs)
1 / Lease hold/free hold land
2 / Cost of development of the land
3 / Building under construction:- :
(a)Amount paid to the building contractors
(b)Amount paid to for building materials
(c)Amount paid for wages and salaries etc.
for the building construction
Architect’s fee
4 / Electrical Installation
5 / Plant and Machinery.
a) Value paid for items at site (break up details to be furnished separately).
b) Advance payments to machinery suppliers (break up details to be furnished separately).
6 / Loading, unloading, transportation, octroi duties, Erection expenses etc.
7 / Pre-operative expenses to be capitalised
8 / Preliminary expenses to be capitalised
9 / Miscellaneous fixed assets
(a)
(b)

We have checked the books of accounts of the unit, the invoices etc., and certify that the aforesaid information furnished above has been verified and found to be true. We also certify that all the aforesaid items have been paid and no credit is raised there against in the books of the unit.

CHARTERED ACCOUNTANTS

Place:

Date: