FORM IPS-II - (See paragraph 5 (g) of the Scheme) - Industrial Park Scheme, 2008

FORM IPS-II (See paragraph 5 (g) of the Scheme) 1. Name of the Undertaking: 2. Equity structure (Give brief details of entities holding the equity in the undertaking) S.No. Details of entity Percentage of equity held a) Public holding b) Private holding Total 3. Details of entities holding more than 20 per cent. of equity in the undertaking:- Name__________________________________________________________ Post address_____________________________________________________ Pin Code_______________________________________________________ Tel. No.________________________________________________________ Fax No.________________________________________________________ Email__________________________________________________________ Permanent Account No.___________________________________________ Percentage of proposed equity holding________________________________ 4. Address of location of Industrial Park (Indicate complete address) Plot No.________________________________________________________ Name of the Building (if any)_______________________________________ Survey Number__________________________________________________ Village_________________________________________________________ Taluka or Tehsil__________________________________________________ District_________________________________________________________ State___________________________________________________________ Pin Code_______________________________________________________ 5. Important details S. No. Items Proposed Actual Reasons I Capital outlay for the Industrial Park (Rs. In lakhs) II Total Foreign equity existing (Rs. in lakhs) III Allocable area of the Industrial Park (in square metres) IV Number of industrial units in the project V Employment Generation Direct Indirect Direct Indirect i) Skilled ii) Semi-skilled iii) Unskilled iv) Total VI Allocable area for Industrial use (percentage) VII Allocable area for commercial use (percentage) VIII Expenditure on Infrastructure development IX Details of infrastructure facilities in the park with amount of investment (Rs. In lakhs) S. No. Item of infra-structure (Rs. in lakhs (Rs. in lakhs) X Date of commencement of Industrial Park 6. Detail of industrial units located in the park: S. No. Name Permanent Account Number (PAN) Nature of manufacturing activity Allocable area 7. List the names of industrial units out of _________________ names listed at 6 above, who are associated _________________ entrepreneurs in terms of section 92A of the _________________ Income-tax Act, 1961.