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					                                     PROFORMA

    APPLICATION FOR DISBURSEMENT UNDER THE 20 PER CENT CAPITAL
INVESTMENT SUBSIDY SCHEME FOR INFORMATION TECHNOLOGY INDUSTRIAL
                              UNITS

1   Name of the applicant
2   Address for communication


                                         Phone
                                           Fax
                                         e-mail
3   Name & address of the Industry
                                         Phone
                                           Fax
                                         e-mail
4   Whether sole proprietorship/ Partnership/
    Pvt. Ltd./ Public Ltd.
5   Name of the products manufactured
    (Approved)
6   Date of commencement of production
    (copy of SSI PMT registration certificate to
    be enclosed)
7   Whether the project for the new unit         Yes /No
    /expansion of the unit has been approved
    by the following financial institutions
    /Banks viz.
    1.
    2.
    3.
    4.
8   The cost of the project approved by the above institution /bank and the details of
    fixed assets acquired are as under

                       Item                                Cost of the Project
                                                                  (Rs.)
                                                  Self Financed Financial Institution
    Total fixed capital investment
                  Land

                 Building

                 Plant and Machinery

                 Other assets

    Tools, Jigs and moulds
     Goods Carriers

     Other assets

     Promotional and pre-operative expenses
     capitalised or to be capitalised.

     Working capital

     Whether certificate from the financial         Yes /No
     institution / bank is enclosed
9    Plant and Machinery
     Sl. Details of the        Name & Address Invoice/ Value   When          Subsidy
     No                        of the supplier bill No.        installed     Amount
          machinery
                                              & date                         Claimed




10   Performance of the Unit
     Year           Investment   Employment   Export      Domestic         Total
                                 Generated    turnover    turnover         turnover




11   Employment proposed or likely to be
     created is as follows:-

                    Managerial

                    Supervisory/Technical
                    Workers
                          Skilled
                          Semi-skilled
                          Unskilled
                    Others
The following certificates have been appended :

    (a) A Certificate from chartered accountant M/s …………………certifying the extent of share capital
        subscribed and paid up value of fixed assets, if any, acquired and paid for as stated above.

    (b) A copy of the latest audited accounts of the unit is also enclosed herewith.

I/We hereby agree that, I/We shall forthwith repay the amount disbursed to me/us under this scheme, if the
amount of 20 percent investment subsidy is found to have been disbursed in excess of the amount actually
admissible for whatsoever reason. Further, I/We shall also be liable to pay interest at cent and such other
charges/expenses which may be payable by me/us.

It is hereby further certified that I/we have not hitherto applied for or have received any amount by way of grant
or subsidy in respect of this unit from any other Department/ Agency of Government of Pondicherry

I/We hereby agree that I/we shall not shift the machinery /Unit for a period of five years from the date of
areement. In the event shifting I/we agree to pay the subsidy amount along with penal interest at such rate as
may be prescribed by the Govt. from time to time.


                                                                                       Signature of the applicant.


                                                          Name of the Signatory.
                                                          For and on behalf of (Name of the Unit)
                                                 ANNEXURE – I


(Certificate from the concerned financial institution/bank in the following form duly signed by responsible officer)


       Certified that M/s…………………………………………………have been disbursed on
this date loan amounting to Rs…………… sanctioned under letter No………………………
Dated……………… as shown below:
                                                                 Rs.
  1 Loan amount previously disbursed upto

       Present installment disbursed on
  2    Total amount disbursed upto date

  3    Value of fixed capital investment

                         Land (Excluding house-hold)

                         Building (Excluding residential quarters)

                        Plant & machinery (including (a)
                        Expenses regarding technical know-how;
                        (b) Engineering fees; (c) Cost of
                        feasibility study; (d) Promotional and pre-
                        operative expenses capitalised).

                        Other assets, Tools, Jigs, Dies and
                        Moulds: and Goods Carriers.


                                                                       Total

Certified that the sanction of financial assistance to M/s…………………………………… for
the plant at ………………………….. has been considered on the basis of the company’s
assessed requirements of civil works and buildings, as shown below:


                                                                             Value (Rs.)
Proposed building for factory

The above value is considered as reasonable and in need for the plant.


                                                                    Signature of the Agent or Manager
                                          ANNEXURE-II

Name of the Chartered Accountant(s):

We hereby certify that………………………………………………………………( Name of the
Industrial unit) have acquired the following machinery for their unit at ………………….
…………………………………………………………………………………….. (Address) for the
manufacture of …………………………………………………………….. (Name of the product)
by the Industrial unit.

                               Item of fixed assets                           Value (Rs)
 1   Lease hold/free hold land
 2   Cost of development of the land
 3   Building under construction:-                           :
          (a) Amount paid to the building contractors
          (b) Amount paid to for building materials
          (c) Amount paid for wages and salaries etc.
          for the building construction
            Architect’s fee
 4   Electrical Installation
 5   Plant and Machinery.
     a) Value paid for items at site (break up details to be furnished
     separately).

     b) Advance payments to machinery suppliers (break up details
     to be furnished separately).
 6   Loading, unloading, transportation, octroi duties, Erection
     expenses etc.
 7   Pre-operative expenses to be capitalised
 8   Preliminary expenses to be capitalised
 9   Miscellaneous fixed assets
            (a)
            (b)

We have checked the books of accounts of the unit, the invoices etc., and certify that the
aforesaid information furnished above has been verified and found to be true. We also
certify that all the aforesaid items have been paid and no credit is raised there against in the
books of the unit.

                                                                 CHARTERED ACCOUNTANTS
Place:
Date:

				
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posted:9/5/2011
language:English
pages:5