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APPLICATION FOR SETTING UP OF SPECIAL ECONOMIC ZONE

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..... __ Name and address of each of the Directors/Partners/Promoters, as the case may be __________________ Nature of the applicant Firm or Company: Public Limited Company Private Limited Company Proprietorship Partnership Others (please specify) Note:- Copy of certificate of incorporation alongwith Article of Association and Memorandum in case of companies and partnership deed in case of partnership firms may please be attached. (i) Location of the proposed Special Economic Zone: Whether the proposal is for - Special Economic Zone for Multi Product. Special Economic .....

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..... llion U.S. Dollars Source of FDI (Country and Company details may be provided); Equity including Foreign Investment (i) ($ Thousand) (Rs.lakhs) (a) Authorized ..................... ..................... (b) Subscribed ..................... ..................... (c) Paid up Capital ..................... ..................... Note: If it is an existing company, please give the break up of the existing and proposed capital structure. .....

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..... of factory buildings and warehouses. Any other activity which may be required in the processing area. Area proposed to be developed as non-processing area. Activities proposed in the non-processing area, namely:- Residential. Commercial complex. Recreation facilities. Social amenities - give details. Others - specify. Standards of operation and maintenance of the facilities proposed. Indicate exports and direct and indirect employment likely to be generated during the first five year period. (Attach a Project Report outlining the economic and commercial viability of the proposal) .....

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..... onomic Zones Act, 2005 and rules and orders made thereunder. I/We hereby declare that the above statements are true and correct to the best of my/our knowledge and belief. I/We will abide by any other condition, which may be stipulated by the Government of India or the State Government. I/We fully understand that any Letter of Approval granted to me/us on the basis of the statement furnished is liable to cancellation or any other action that may be taken having regard to the circumstances of the case if it is found that any of the statements or facts therein are incorrect or false. An affidavit duly sworn in support of the above information is enclosed. Place : ..................... Signature of .....

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..... es? Whether the land has existing structures or is vacant ? Whether the land is contiguous? Projected investment in the project. Projected exports from the project. Projected employment from the project. Share Capital and Reserves of the Developer Company. Source of funds for the project. Net worth of the Applicant (including Group companies) duly supported by Audited Accounts of the Developer for last 3 Years (for all the constituents in case the Developer is a SPV). If the company is a new company, audited accounts of Flagship Company/promoters may be provided. Extent of FDI (if any) in million U.S. Dollars. Source of FD .....

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