TMI BlogCONSOLIDATED APPLICATION FORMX X X X Extracts X X X X X X X X Extracts X X X X ..... Tax registration; Approval from Inspectorate of factories; Pollution control clearance, wherever required; Any other approval as may be required from the State Government. The application should be submitted to the Development Commissioner of the concerned Special Economic Zone in 5 copies along with a crossed Demand Draft of rupees five thousand drawn in favour of The Pay Accounts Officer of the concerned Special Economic Zone together with a project report giving details of activities proposed. For Official Use only Application No. ............................. Date: ............................. ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Constitution of the applicant firm: Public Limited Company [Tick (v) appropriate entry] Private Limited Company Partnership Proprietor ship Others (please specify) (Attach copy of Certificate of Incorporation alongwith Articles of Association and Memorandum of Association in case of companies and partnership deed in case of partnership firms.) Nature of the industrial undertaking0 Large scale Medium scale Small scale Name and c ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... (Value in Rupees) Import Indigenous Capital Goods Raw material, components, consumables, packing material, fuel etc. for 5 years (Give details in project report, namely list of Capital Goods, description of raw materials, and other inputs, etc). TOTAL: ................................ INFRASTRUCTURE REQUIREMENTS Requirement of land: - (Area in sq. mtrs.) factory offices Warehousing/storage Others, specify Requirement of built-up area ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... f existing and proposed capital structure. (ii) Pattern of share holding in the paid-up capital (Amount in Rupees) (Rs. in lakhs) (US $ Thousand) (a) Foreign holding ............. ............. (b) Non Resident Indian company/Individual holding (i) Repatriable ............. ............. (ii) Non-repatriable ............. ............. ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... Net Foreign Exchange earnings For the first five years (1) (2) *Foreign exchange outgo shall include the CIF value of import of machinery, raw material, components, consumables, spares, packing materials and amount of repatriation of dividends and profits, royalty, lump sum knowhow fee, design and drawing fee, payment of foreign technicians, payment on training of Indian technicians abroad, commission on export, interest on external commercial borrowings, interest on deferred payment credit and any other payments. OTHER INFORMATION (i) Whether the applicant has been issued any Industrial license or LOI/LOA under EOU/SEZ STP/EHTP scheme. If so, give full parti ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... UNDERTAKING I/We hereby declare that the above statements are true and correct to the best of my/our knowledge and belief. I/We shall abide by any other condition, which may be stipulated by the Development Commissioner. I/We fully understand that any Permission Letter/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 furnished are incorrect or false. Place : ..................... Signature of the Applicant ..................... Date : ..................... ..... X X X X Extracts X X X X X X X X Extracts X X X X
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