FORM AKINFRA

KERALA INDUSTRIAL INFRASTRUCTURE DEVELOPMENT CORPORATION

(A STATUTORY BODY OF GOVERNMENT OF KERALA)

TRIVANDRUM

KINFRA HOUSE

TC No. 31 / 2312Phone: 91 – 471 - 2726585

Sasthamangalam Fax: 91 – 471 –2724773

Trivandrum – 695 010E-mail:

Keralawebsite:

APPLICATION FOR REGISTRATION

“FORM A”

Park Name:

A. DETAILS OF THE APPLICANT

01.a.Name of the Chief Promoter:

b.Address:

c.PIN code:

d.Phone No.:

e.e-mail:

f.Mobile No (***):

g.Bank Details(***):

1. Name of Bank:

2.Account No.:

3. Bank Code:

4. IFSC Code of Bank:

02.a.Names and address of the other Promoters (if any) and % of share capital

  1. :
  1. :
  1. :
  1. :

B.DETAILS OF EXISTING ORGANISATION (if any)

01. Name of Organization:

02.Address of the Organization:

03.Phone No.:

04.Name of the Product(s) manufactured:

C.BRIEF DETAILS OF THE PROPOSED PROJECT

01.Name of the Product(s):

(with details)

02. (***) Raw material used

03. (***) Finished Products

04.Category of Industry as per Pollution

Control Board standards (Please Tick):

05.(***) Production flow chart submitted :

06.Proposed Investment (in lakhs)

a.Built-up space: Rs.

(in case opting for land)

b.Plant and Machinery: Rs.

c.Auxiliary Services: Rs.

07.Area required

a.Land in cents:

b.Built-up space in sq.ft.:

08. Name of the Industrial parkwhere land to

be allotted:

9.Utilities required (***)

a.Amount of Power (in KW):

b.Quantity of Waterin Litre per day :

10. Whether the applicant had own

Warehousing facility :

(if Yes, Please provide details separately )

11.Manpower to be employed:

12.Installed capacity of Plant:

13.Proposed form of implementing agency(Please tick)

  1. Proprietary
  1. Partnership
  1. L.L.P
  1. Private Limited Company
  1. Public Limited Company

(Submit details)

14.Proposed date for commencement

of commercial production:

15.Preferred mode of payment:

(Please tick)

  1. R.T G S payment:

(StateBank of India, ALTHARA Branch, Trivandrum

Account No. 3176 3060 697 IFS Code SBIN0007203)

  1. Demand Draft:

Signature

Designation

Seal

Place:

Date:

(***) Mandatory

Annexure to FORM A

D. ADDITIONAL DETAILS TO THE PROPOSED PROJECT

01.Name of the Product(s):

(with details)

02. Raw material used

  1. …………………..
  2. …………………

03. Finished Products

  1. ………………………
  2. ………………………

04. Whether the applicant has own warehouse facility :

(if Yes, Please provide details separately )

05. Category of Industry as per Pollution Control Board standards

(Please Tick)

06. Production flow chart submitted :

Signature

Designation

Seal

Place:

Date:

TERMS AND CONDITIONS OF

APPLICATION FOR REGISTRATION (FORM A)

  1. This is an “Application for Registration” only.
  1. The “Application for Registration” duly filled in may be sent to the Managing director, Kerala, Industrial Infrastructure Development Corporation, KINFRA House, TC 31 / 2312, Sasthamangalam, Trivandrum – 10.
  1. The submission of “Application for Registration” shall not be construed as any commitment or obligation on the part of the Corporation that any plot shall be allotted to the applicant.
  1. Your application for registration shall be accompanied with a registration fee of Rs. 5,000/- (Rupees Five thousand only), plus service tax by way of Demand Draft drawn in favour of Managing Director, Kerala Industrial Infrastructure Development Corporation, payable at Trivandrum.
  1. Detailedprofile of the proposed project is to be submitted along with the Application for Registration.
  1. The Registration fee Rs. 5,000/- is refundable if firm allotment is not made.
  1. The selection of allottees among the registered applicants will be made by a Committee duly constituted for this purpose.

I / We agree to the above terms and conditions of the Application for Registration.

Place:

Date:

Signature

1