FORM IPS-I - Application for consideration under the Industrial Park Scheme, 2008 - Industrial Park Scheme, 2008

FORM IPS-I (See Paragraph 3 of the Scheme) Application for consideration under the Industrial Park Scheme, 2008 1.I Name and address of the Undertaking (Indian or International) in full (Block Letters): (a) Registered Address: Name of the Undertaking_____________________________ Name of the contact person____________________________ Postal Address______________________________________ Pin Code____________________________ Tel. No._____________________________ Telex_____________ Fax No._____________________________Cable______________ E-mail_____________________________________ (b) Address for correspondence (if different from (a) above): Name of the Undertaking_____________________________ Name of the contact person____________________________ Postal Address______________________________________ Pin Code____________________________ Tel. No._____________________________ Telex_____________ Fax No._____________________________Cable______________ E-mail_____________________________________ 1.II. Registrar of Companies Registration No._______________________ (If registered) 1.III Status of Undertaking (1) Central Government Undertaking (7) Individual Promoter (2) State Government Undertaking (8) Foreign or Non Resident Indian or OCB Company (3) State Industrial Government Corporation (9) Foreign or Non Resident Indian Individual (4) Cooperative Undertaking (10) Partnership Firm (5) Joint Sector Undertaking (11) Registered Societies (6) Private Sector Undertaking (12) Any other (please specify) 1.IV Equity structure in the undertaking:- (a) Total Equity of the undertaking (in Rs. Crores)_________________ (b) 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 (c) 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___________________ 2.I Proposed location of the Industrial Park 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______________________________________ 2.II Details of the proposed Industrial Park (a) Total proposed constructed floor area (in square metres)____________ (b) Total allocable area (in square metres)__________________ (c) Proposed allocable area for industrial use (in square metres)_____________ (d) Proposed allocable area for commercial use (in square metres)_____________ (e) Allocable area earmarked for industrial use (percentage)___________________ (f) Allocable area earmarked for commercial use (percentage)_________________ 2.III Details of manufacturing activities to be undertaken by industrial units: ____________________________ ____________________________ ____________________________ 2.IV (a) Minimum number of industrial units to be located______________ (b) Employment likely to be generated - Details Direct Indirect Total i) Skilled ii) Semi-skilled iii) Unskilled iv) Total 2.V (a) Proposed investment (Amount in rupees in lakhs) (b) Investment on Infrastructure Development (Amount in rupees in lakhs) (c) Percentage of (b) to (a) (d) Complete details of infrastructure facilities proposed to be provided in the industrial park S. No. Item of infrastructure Investment (Rs. In lakhs) 2.VI Total foreign equity existing (Amount in rupees in lakhs) ___________________ 2.VII Expected or Actual Date of Commencement of Industrial Park ______________ 3.I Whether the industrial park is located or developed Yes/No as a separate identifiable area 3.II Whether the industrial park is independent Yes/No of other projects or is an extension or part of any other project 3.III The nature of title the undertaking ______________ holds on the land on which the project ______________ is situated ______________ 3.IV Whether the project is developed under Yes/No any agreement and if yes, the address ______________ of other parties (other than applicant) ______________ to such an agreement ______________ 3.V Whether the applicant undertaking has Yes/No powers to allow industrial and commercial ______________ units as proposed in the application to operate ______________ from the industrial park mentioned in the appli- ______________ cation.(If there is any type of restrictions in this regard please indicate the same) 3.VI Whether all the criteria as mentioned in para 4 of the Industrial Park Scheme, 2008 are met or not: (a) The date of commencement of the Industrial Park Yes/No should be on or after the 1 st day of April 2006 and not later than the 31 st of March 2 [2011]; (b) The area allocated or to be allocated to industrial Yes/No units shall not be less than ninety per cent of the allocable area; (c) There shall be a minimum of thirty industrial Yes/No units located in a industrial park; (d) For the purpose of computing the minimum Yes/No number of industrial units; all units of a person and his associated enterprises will be treated as a single unit. (e) The minimum constructed floor area shall Yes/No not be less than 50,000 square meters; (f) No industrial unit, along with the units of Yes/No an associated enterprise, shall occupy more than twenty five per cent of the allocable area; (g) The industrial park should be owned by only Yes/No one undertaking; and (h) Industrial units shall undertake only manufactu- Yes/No ring activity as defined in Section D of the 1[ National Industrial Classification, 2004 Code] issued by the Central Statistical Organisation, Department of Statistics. DECLARATION I/We hereby undertake to continue to operate the Industrial Park during the period in which the benefits under sub-section 4(iii) of the section 80-IA of the Income-tax Act, 1961 are to be availed. I/We hereby certify that the above statements are true and correct to the best of my/our knowledge and belief. ___________________________ (Signature of Applicant) (Name in Block Letters) ____________________________ (Designation of the Signatory) -------------------------------------- Place:_____________ Date:______________ List of Enclosures 1.__________________ 5._____________________ 2.__________________ 6._____________________ 3.__________________ 7._____________________ 4.__________________ 8._____________________ ***************** Notes : 1. For the words and figures National Classification, 2004 Code , the words and figures National Industrial Classification, 2004 Code has been substituted vide Notification No. 76/2008 dated 2/7/2008 . 2. Has been substituted vide notification no. 37/2010 dated 21-5-2010 , earlier it was read as, 2009