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Annexure No


									                                                 Annexure No 1
                              FORMAT OF THE REQUEST FOR OBTAINING
                               “NSIC-SMERA Performance and Credit Rating”
                                        To be printed on the Applicant’s Letter Head

SME Rating Agency of India Ltd.
Seagull House, 1 Floor,
Plot No.6, Shivaji Colony,
Andheri-Kurla Road,
Chakala, Andheri (East),
Mumbai – 400 099

Dear Sir,
I / We desire to get “NSIC-SMERA Performance and Credit Rating” of my/our unit by SME Rating Agency of
India Ltd

I / We attach herewith Application Fee of Rs ________ /- [inclusive of all taxes] by way of Cheque / DD No
____________ Dated favour of “SME Rating Agency of India Ltd”.

The Application Form as per Annexure – 2 and the documents as listed out in Annexure – 3 are enclosed
1] A] I/We declare that we have not availed of the subsidy benefit towards the rating fees through NSIC from
the Government of India in respect of any other agency.”
   B] “I/We undertake to furnish the desired information and clarifications as required by SMERA during the
rating process within a reasonable period of time and in any case within a period of 15 days from the date of
application form. I/We understand that in the event of our request for rating being treated as closed by
SMERA due to non-receipt of complete information, 50% of the fees paid by me/us would be forfeited by
SMERA. I/We also understand that if SMERA has carried out the inspection process and the application is
then closed for want of complete information, no amount would be refunded back.”

2] I / We certify that the details given in this application are true and correct and no material fact has been
concealed or withheld. Further, I / We consent to accept the rating assigned by SMERA as final.

Signature & company seal __________________________
Name of the Signatory________________________________
Designation __________ ______________________________
Company Name _____________________________________
City _________________ Pin ___________________________
Email Id : _________@____________________
Tel. No.________________________ Fax No. ______________

Date _______________________________________________
Place _______________________________________________

1] The application is to be submitted in duplicate. All documents should be submitted complete in all respects
to avoid delay in processing.
2] Check for net fee to be submitted under the NSIC Subsidy Scheme as per rating fees chart mentioned
below. Kindly note that the rating fees is inclusive of applicable service tax.

                                                                                         (all figures in INR)
            Category     Networth                      <50 Lakhs              50-200 Lakhs    >200 Lakhs

                A        >20 Crore                      33,708                  28,090        15,450
                B        5 crore to 20 Crore            16,854                  11,236        11,236
                C        1 Crore to 5 Crore              8,427                   8,427         8,427
                D        upto 1 Crore                    5,618                   5,618         5,618
                                            Annexure No 2
                                       APPLICATION FORM

1.  Name of the Applicant
    and Address of Head
    Office                Pin code_________ Phone____________Fax___________

      * Factory:
     Please give address of
     all the factories / works   Pin code_________ Phone____________Fax___________

     Registered Office

                                 Phone____________Contact Person___________

     Branches / Others

                                 Pin code___________ Phone__________Fax ___________
2.   Constitution:
     Proprietorship/ Partnership/ Private
     Ltd/ Limited Co./ Coop. Society
3.   Established in year:
4.   (a) Nature of Industry

     Is the unit an SSI                        Yes / No

     (b) Products

5    * Details of Promoters :
     Name(s) of Proprietor / Partner / Director:
     Address :
     Phone Nos / Mobile Nos:
     Name of contact Person for SMERA Rating :

     Phone No & Mobile No :

6.   Name and Address of
     Associate Concerns

7     Details of existing borrowings / banking arrangements
     Name & Address of Fin. Instts. /       Account         Nature of            Loan Amount
     Bank / Lenders (from whom the unit Number              assistance &         (Rs.)
     has availed loan / credit limit)                       Address / loan limit
                                                            & Address availed

* For details please attach separate sheets.

Signature __________________

Name of the Signatory ________________________ Designation ___________
                                                Annexure No 3

                                           CHECK LIST

 1         Copy of the audited accounts for the latest three financial years
           (i.e. 2003-04, 2004-05, 2005-06) along with schedules, auditors        FY 04      FY 05
           report, Director’s report , notes to account and Form 3 CD & 3         3CD &      3CD     FY 06 3 CD &
           CB, wherever applicable.                                               CB         &CB     CB
 2         Copy of Insurance policies along with annexure (stock, plant &
           machinery, building, etc).
 3         Banker's confidential letter in sealed envelope from all the
           existing Bankers.
 4         Production Capacity & Actual Production breakup - Product wise
           for FY 2004, 2005 & 2006.
                                                                                  2004       2005    2006
 5         Partnership Deed / Memorandum & Article of Association ;
           Details of Shareholding / profit-sharing ratio.
 6         List of all Partners / Directors with Age, Address, Qualifications ,
           Experience and details(Name of Co , Line of Business and
           address of Co, )where they have interest(shareholding) in other
           Co.(In attached format)
 7         Individual Networth Statement of Proprietor / all partners / all
           directors along with annexure .
 8         List of plant and machineries as on date.

 9         Employee base with bifurcation of Contractual & Permanent
           employees for the year 2005 and 2006.
                                                                                  2005       2006
 10        Copy of Small Scale Industry Registration Certificate.

 11        Copy of Central Sales Tax Registration Certificate and State           Central    State
           Sales Tax Reg. certificate.                                            ST         ST
 12        Brief write-up about products manufactured, end users,                 Brief of   Marke   Orders in
           marketing tie-up and orders in hands.                                  Product    ting    Hands
 13        Copy of Quality certificates, Pollution Control Certificate ,
           awards won, membership of any associations.
 14        Details of subsidy, tax concession available to the applicant

 15        In case of new project/expansion, copy of the project report
           containing a brief project profile, cost of project, source/means of
 16        You may provide any other information for better understanding
           of your business.
 17        Bank Statement of a/c for one year for all the Loans and Banks)                           Hire
                                                                                  Cash       Term    purchases and
                                                                                  Credit     Loan    Others
 18        History of Change in Constitution , Name
           ( History for Change in Capital for Pvt Ltd and Ltd Co as per
           format attached).
 19        Sanction Letter of Credit from Existing Bank

*** If any item is not applicable Please strike it off in check list and provide us separately rational for
the same.
                                         Annexure No 4


  PRODUCT NAME          : ****************

  Period              : 2003 to 2004
  Actual Output       : ***** Units per year
  Production Capacity : ***** Units per year

  Period              : 2004 to 2005
  Actual Output       : ***** Units per year
  Production Capacity : ***** Units per year

  Period              : 2005 to 2006
  Actual Output       : ***** Units per year
  Production Capacity : ***** Units per year

                                         Annexure No 5


Customer Name    Product Description   Quantity (in pieces   Order Value (in INR)

                                         Annexure No 6

                             LIST OF PLANT & MACHINERY SAMPLE FORMAT

            S.No                   Quantity   Year of Installation   Original Cost








                                                        Annexure No 7

                            Net Worth Statement as on **/**/2006 SAMPLE FORMAT

                                                                          AMOUNT IN    Charged
           S.NO    DESCRIPTION
                                                                          INR(Lakhs)   Mortgaged/Hypo
                                                                                       to Bank/FIs
                   Movable Assets
                   Cash & Bank Balance

                   Govt. Securities


                   Life Insurance Policies

                   Post Office Annuity Deposited


                   Investment In Business

                   Investment in Associate

                   (Please specify movable assets in detail)

                   Immovable Assets
                   Land & Building

                   (Please specify immovable assets in detail)

           3       Total Assets       (A)

           4       Total Liabilities (B)

                   (Please specify all liabilities in detail)

           5       Net Worth          (A –B)

Please provide details of personal guarantees offered and the corresponding liabilities.

                                                        Annexure No 8

                               DETAILS OF EMPLOYEES SAMPLE FORMAT

No. of Employees :
Type of Employees                          Current year                    Previous year
                                      Permanent      Permanent          Temporary      Temporary
1. Production Workers
2. Other
                                                         Annexure No 9
                                            Banker’s Confidential Report
    Please attach to the form a confidential credit report from your principal banker placed in a sealed envelope. This credit
    report should be in the following format: (Note: in the following format, “subject” refers to your company as a client of
    the bank)

                                       To be printed on Bank’s Letterhead

    Date : ________________

    To SME Rating Agency of India Ltd

    Dear Sir

    We submit herewith “Banker’s Report” as required by you, for our client M/s ________________________
    __________________________________            (Your company name with address).

    With respect to the above mentioned subject we state as under:

  How long has the subject been your customer? Are the dealings with the subject and its sister companies

    Has the interest payment from the subject been timely? Have their been any defaults by the subject or its
    sister companies? If yes, please give the details during last one year.

        A brief profile of the subject’s financial relationships with its suppliers and customers (any dishonoring of
        cheques due to insufficient fund) during last one year.

    Loan Particulars:
                              Amount Sanctioned /        Amount Disbursed                     Amount overdrawn
                              Limit (Rs in _________)    (Rs in _______) as of current date   (Rs in _________)
    Cash Credit/Working
    Capital Demand Loan
    Any other Fund based
    Non-fund Based
    Yours truly,

    Authorised Signatory
    For __________________Bank
                                                      Annexure No 10

Background Information on Chief Executive Officer/Proprietor/Partners/ Directors
Name            :_                            ________________________ Designation :_ ________
Address         :                    __________________________
Telephone      : ________________________                 Email ID    :_
Passport No : ____________________________                     DOB / Age : ____________
Qualifications : ________________________________________________________________________
Date of Joining the Subject : ______ Date on which assumed the Current Position : ___
Whether Founder of Subject : Yes/             Years in Related Field ___ Total Experience: ___
Whether active in day to day Operations/ Business : Yes/ No
Whether retired/ Resigned : __________________________________________________________________
Past Work Experience :
1 .Name of the Company: __ Last Position Held : ____ Period _
2. Name of the Company: __________________________ Last Position Held : ____________ Period ________

Other Directorships (Please give particulars)

                                                     Annexure No 11
History of Change of Capital for Private Limited and Limited Company

Please provide details of Change in Capital in below format

DATE OF CHANGE                    :
CAPITAL TYPE                      : Authorized Capital
NATURE OF CHANGE                  : Increased
FROM                               : Initial Capital as per MOA
TO                                : ****

DATE OF CHANGE                    :
CAPITAL TYPE                      : Paid-up Capital
NATURE OF CHANGE                  : Increased
FROM                               : ****
TO                                : ****
CONSIDERATION                     : Cash /Right issue/Bonus

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