1.

(a)

Name of the Applicant Unit

:

(b)

Local Office Address

:

Telephome number

:

Fax No

:

E-mail Address

:

(c)

Address of the Registered Office

:

Local Office Address

:

Telephone number

:

Fax No

:

E-mail Address

:

(d)

Name & Designation of the Promotions

:

Local Office Address

:

Telephome number

:

Fax No

:

E-mail Address

:

2.

Whether the Project is for

     (Please tick any)

(a)

Esrablishment of a new unit

:

(b)

Expansion project in the existing unit

:

(c)

Expansion project in a new location

:

3

(a)

Constitution      :   

Private Ltd / Public Ltd / Co-operative / Partnership / Other (tick whichever is applicable)

(b)

Date of establishment / incorporation / registration of company / Co-operative

:

4.

Location / Address of the unit

:

(a)

Location of the Project

:

Police Station

:

Municipality / Bank

:

Post Office

:

District

:

State

:

Whether notified area [Backward / Tribal etc.]

Telephone No

:

Fax No & E-mail address

:

(b)

Location of any other units of the promoter / (s) (if any)

Location

:

District

:

State

:

Location

:

District

:

State

:

5.

Project Cost

:

5.1

New Scheme / Expansion Scheme