APPLICATION FORM FOR PERMANENT …

1 GOVERNMENT OF DELHIOFFICE OF THE COMMISSIONER OF INDUSTRIESCPO BUILDING, KASHMERE GATE, DELHI - 110 066 APPLICATION form FOR PERMANENT registration ASSMALL SCALE INDUSTRIES(TO BE FILLED IN DUPLICATE) in block (capital) up whichever is English alphabets/Arabic numbers while filling up blocks (to help computerisation).Leave one blank after each filling the form , use the following procedure :(i)Name of unit KAMAL ENTERPRISES / ENTERPRISES(ii)Pin Code : 110041(iii)Date : 23rd June 1959(iv)Quantity (kg) 90 kg.(v)Amount (Rs. in thousands) Rs. 5000/-(v)Fill up appropriate codes in the block wherever 1:Yes - 1, No. - 2, NA-3. If NA fill up-3 K A M A L E N T E R P R I S E S G K E N T E R P R I S E S 1 1 0 0 4 1 2 3 0 6 5 9 0 0 0 0 9 0 0 0 0 0 5 31 Example 2:Category : SSI-1, Anc-2 Tiny-3, SSSBE-4,EOU-5If Tiny fill marked (*) are to be filled by should sign all copiesAbbreviations used :SSI : Smal Scale Industries, ANC : Ancillary Industrial undertaking, SSSBE : Small Scale Serviceand Business Enterprises, TINY : Tiny enterprises, EOU : Export Oriented Unit, NA Not OF DELHIOFFICE OF THE COMMISSIONER OF INDUSTRIESCPO BUILDING, KASHMERE GATE, DELHI - 110 registration of of Commencement of of of : Pin Code.

2 Of UnitSS1-1, ANC-2, SSSBE-3, TINY-4, of LocationRural - 1, Urban -2, of organisation :Proprietary - 1, Partnership - 2, Pvt. Company - 3, Cooperative - 4 Others - of activity :Manufacturing/Assembly (01)Processing (02)Job work (04)Repairing/Servicing (08) items of manufacture/activities.(details of capacity to be furnished in Appendix A )(i)NameCode :*(ii)NameCode:*(iii)NameCode:*(iv)NameC ode:*(v)NameCode:* in Fixed assets (Rs. in 000)(i)Land(ii)Building(iii)Plant and Machinery(iv)Other fixed in Plant and Machinery(original value Rs. in 000)(Datails to be furnished at Appendix B ) Material requirementName*Item CodeImported - 1 Annual ConsumptionIndigenous-2value (Rs. in 000)(i)(ii)(iii)(iv)(v)Other Raw MaterialsTotal (i) to (v) of PowerCoal - 01, LPG-04, Oil - 02, Electricity-08, Non-conventional energy-16,Traditional Load(1 = ) (i)Management & Office Staff(ii)Supervisory and Registered under Factories ActYes-1, s profileMale - 1 Female - 2SC-1ST-2 Engineering Graduate-1 Other Graduate-2 Others-3 Date : Signature of ApplicantName of proprietor/partner/managing directorFOR OFFICE USE ONLYA pplication No.

3 NIC CodeBlock CodeDistrict Code State CodeWhether the items of manufacture/activity require an industrial licence. Yes-1, (no industrial licence is required for items listed in Schedule II of the licencing notification dated the unit employs less than 50/100 workers with/without power)6 GOVERNMENT OF DELHIOFFICE OF THE COMMISSIONER OF INDUSTRIESCPO BUILDING, KASHMERE GATE, DELHI - 110 066 CERTIFICATE OF REGISTRATIONThe unit is permanently registered as a SSI/SSSBE unit of the manufacture of items/activities as statedin the APPLICATION form and briefly noted below :Item of manufacturing/activity (S. No. 11 & Appendix-A) in Plant and Machinery ( 13 & Appendix - B)Rs. in 000 PERMANENT registration No. :Date of Issue :Category of unit (S. No. 6)7 GOVERNMENT OF DELHIOFFICER OF THE COMMISSIONER OF INDUSTRIESCPO.

4 BUILDING, KASHMERE GATE, DELHI - 110 066 FOR TINY ENTERPRISESThe unit is a tiny enterprises and its status as tiny enterprise is valid is extended is extended upto ..SignatureDate : Name & designation of Registering endorsed APPLICATION form is a part of the certificate of certificate is valid for the items of manufacture/activity noted at II and Appendix A andis also valid for nay other item/activity undertaken by the of the status as a tiny enterprise is to be validated/renewed every five years as perprocedure certificates is subject to any affidavit furnished by the applicant is respect of the APPLICATION certificates is subject to any or all the conditions that may be imposed by the at any time it is found that the declaration/affidavit furnished by the applicant is not true orin the event of violation of any of the conditions imposed by the registering authority, or ifthe investment exceeds the prescribed limit.

5 The registration certificate is liable to be cancelledquashed without any prior certificate does not confer or accrue any right to the applicant and cannot be treated asproof in respect of any statutory requirement or condition that may exist under any law forthe time being inforce. The onus of satisfying and fulfilling such requirements or conditionsrests squarely on the in the list of Plant Machinery and the revised investment value thereofand/or any changes in the constitution or location of the unit should be made in the additionalsheets appended to the certificate on the request of the OF DELHIOFFICER OF THE COMMISSIONER OF INDUSTRIESCPO. BUILDING, KASHMERE GATE, DELHI - 110 066 CERTIFICATE OF REGISTRATIONADDITIONAL SHEET -1 registration of IssueAddition / deletion in Plant & MachineryS.

6 Of MachineryAdded/deletedOriginal valueRs. in value of investment in Plant & Machinery (S. No. 13) (Rs. in 000)Change in locations (S. no. 17)Change in constitution/type of organisation (S. )Date : SignatureName & Designation of Registering Authority10 APPENDIX A For any combination and the respective codes(Value in Rs. 000) & by-productsProductUnit ofUnitAnnual *Quantiry*Code* prd. & by-prd. (comb.) (1 to 5) (Combined) (7 to 10) (12 to 14) Total (6+11+15)XXXX11 APPENDIX B DETAILS OF PLANT AND of the (original value) (Rs. in 000) applicant should submit this affidavit in triplicateAFFIDAVIT FOR PERMANENT REGISTRATIONASSMALL SCALE INDUSTRIESFORMATI/We ..son/daughter/wife/widow* of ..resident of .. do hereby solemnlyaffirm and declare as under I/We have submitted an APPLICATION dated.

7 For PERMANENT registrationof the unit as small scale/ancillary. tiny/export oriented unit/Small Scale Service and Businessenterprise.* I/We am/are proprietor(s)/partner(s) Managing Director* of the unit whose name andaddress is given below :Name :..Address :.. all particulars furnished in the APPLICATION form are factual and the location of the unit does not violate any locational restrictions for the time being inforce and that I/We have obtained the necessary locational clearances from the I/We have obtained all the statutory clearances/No Objection Certificates/permissionrequired to carry out the manufacture/activity under the prevalent laws, regulations andrules in I/We have also obtained the necessary registration /licence, wherever, required, under therelevant laws, rules or orders, for the time being in force for carrying out the said industrial the unit does not require an Industrial Licence because :(a)the unit employs less than 50/100 workers with/without use of power.

8 (b)the items proposed to be manufactured are reserved for exclusive production in the smallscale industries sector.(c)the unit does not manufacture any item which is included in Schedule-II of Notification 477 (E) dated and is not reserved for exclusive manufacture in the SSI sector asincluded in Schedule-III of the above the original value of investment in plant and machinery installed at the unit is within the limitsprescribed for tiny/SSI/SSSBE/ancillary/export-oriented units as per existing the unit is not owned or controlled or is a subsidiary of any other industrial undertaking interms of the Notification No. 2(E) dated I/We undertake to inform the registering authority within 30 days of the crossing of the investmentlimits in plant and machinery and submit the registration certificate for cancellation of registration ordeletion of relevant endorsements as ancillary/EOU/tiny enterprises/Small Scale Service and I/We understand that if at a future date the said unit does not satisfy any of the conditions laiddown in the notification No.

9 232(E) dt. , or does not comply with any of the conditionsor restrictions for the time being in force, or includes for manufacture items that require an industriallicence, then in such an eventuality. I/We shall be liable and required to surrender our registrationas a SSI I/We undertake to inform the Directorate or Industries/Registering authority immediately incase a situation arises as mentioned at para 11 I/We undertake to inform and to keep informed that Directorate of Industries/RegisteringAuthority on all parameters and changes, if any, as required from time to I/We undertake to refund to the Central or State Government any or all financial incentives orbenefits given under various schemes of assistance for small scale industries along with 18% interest,as may be demanded by the appropriate authority of Central/State Govt.

10 In case it is found that theinformation or particulars submitted to obtain registration were wrong and I/We fully understand that we have to comply with the above conditions failing which we areliable for action by the Registering authority for cancellation of the registration as well as underother relevant provisions of the laws and rules in that the contents of the affidavit are true to the best of my knowledge and :Place :(*Note) Strike out whichever is not