FORM - Data Bank - Micro, Small and Medium Enterprises Development (Furnishing of Information) Rules, 2016

FORM (See rule 3) Data Bank Basic Details Aadhaar Number: * _____________________________ Udyog Aadhaar Number: * Get UdyogAadhaar __________________ PAN Number: *_______________________ Button to Validate and Get Details: * Validate UAN Enterprise Name: * _________________ Category Unit Size: * ________________ Organization Type: * _______________________________ Major Activity: * ____________________________ State:* ___________________ District: * ____________________________ Pin code: *______________________________ Commencement Date: * ______________________ Email ID: * _____________________ Mobile Number: * _______________________ Communication Address: * ___________________________ Enterprise Social Category: * _______________________ Authorised Person Name: * ___________ Nature of Operation: * _________________ Cluster Name ( If Any): ______________________ Website: ________________ Any Special Category of Entrepreneur ( ) Ex-Serviceman ( ) Person with Disability ( ) Woman ( ) Minority ( ) Registered in the Factory Act 1948? ( ) Unit is an Ancillary? ( ) Registered in Shop and Establishment Act? If any other, please specify _________________ Factory and Product Details Enterprise Address : * ______________________ State: * ____________________________ District * ________________ Pin Code: * ____________________ Person Employed: * __________________ Installed Capacity (Per Annum): * Quantity: _________ Unit: __________________ Investment on Machinery/Plant (Rs. in lacs): * ____________ Power Load: * H.P.: _____________ K.W.: _______________ Enterprise Product Description: __________________________ Major Raw Material used: 1. ___________________ 2. _________________ 3. ________________ Major Buyers: ________________ Turnover Last year (Rs. in lacs): * _______________________ Upload more products: (Upload pdf/doc file max size limit is 1 MB) Add Product Details Product Name ___________ Product Code ______________ Production Capacity ______________Production measurement unit ___________ (Add) Please provide valid unit For Verification and Capacity Certification , Please click here Other Details Bank Name : ___________________ Bank Account No. __________________ IFSC Code: ______________ Add Assistance Details Taken From _______________ Scheme Name _____________ on date _____ (Add) Add Association Details Association Name _______________ Since date _______________ (Add) Hand Holding by Development Organisation( If Applicable) Select Office Name: ________________________________ Add Appreciation/Award Details Appreciation/Award Name ____________________ Details ________________ On Date ___________________ (Add) Additional Requirements 1. Are you using Solar Energy in your organisation/ Factory? _____________ (H.P.) __________________ (K.W.) If No, do you wish to use it? ___________ (H. P.) ____________(K. W.) 2. Have you got energy audit done for your unit? _____________ 3. Do you have Joint Venture? _______________________ If YES, Please provide details. _________________ If No, Do you wish to plan Joint Venture? _____________ 4. Are you exporting? ____________________________ If Yes, Please provide country name 1. _______________ 2. ______________ 3. ____________ 4. ______________ 5. Will you be interested in foreign fairs? ___________ 6. Do you have our own brand? __________ If yes please provide Brand name _____________________ 7. Will you be interested in availing Marketing Assistance Scheme? ____________ 8. Do you intend to participate in Public procurement? _____________ 9. Do you wish to upgrade Technology ____________________ If Yes please specify __________________ 10. Do you wish to import Technology? ___________ If YES, Please specify country. ___________________ Details _____________ 11. Do you intend to transfer your Technology to other MSEs? ___________________ Please specify _______________ 12. Is your enterprise ISO certified? __________________ 13. Is your enterprise has quality certification? ____________________________ Please specify_____________ 14. Will you be interested in Credit facilitation? ________________________ 15. Have you ever been Black listed? __________________ All (*) marked fields are mandatory *________ This is to certify that the information furnished in the Data bank is true and correct to the best of my knowledge and belief. ________ Would you like to avail insurance with discounted premium?