ANNEXURE - II

 

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APPLICATION FOR ALLOTMENT OF GOVERNMENT LOAN OTHER THAN INDUSTRIAL

(INCOMPLETE APPLICATION IS LIABLE TO BE REJECTED)

 

01. Name & Address of the applicant and others.  :

02. Permanent Address                                          :

03. Qualification (produce the true copy of the       

      certificate in available)                                       :

04. Experience (produce the true copy of the

      certificate if available                                         :

05. Present occupation (Government service,

      Semi Government service, Local industries

      un employed).                                                   :

06. Type of Industries to be set up                           :

07. Goods to be produced/service to be rendered   :

08. Name of the SSI units for which land is required

and (a)    Its status i.e. proprietory/partnership/joint

            stock Co.                                                    :

      (b)   SSI registration No. & Dt.(enclose copy).    :

09. Total investment as per the scheme

      (a)     Land and building                                        :

      (b)    Plant and machinery                                     :

      (c)    Others                                                         :

      (d)   Working capital                                            :

           Total                                                             :

Copy of the Scheme approved by DIO or Director of Industries, Orissa and copy of the registration certificate by D.I.C.

 

10. Source of finance                                               :

      (a) From own source                                          :

      (b) From financing institutions.                             :

      (Please show separately for such financing

       institution & different heads).

11. Whether the loan has been sanctioned, if so by

       whom and (enclosed copy of the sanction order).:

12. Whether working capital has been arranged

       (enclosed copy of sanction order from the

       financing institution).                                            :

13. Total requirement of power in K.10 Watt.

14. Total space required for the industries in Sq.ft.

       and ask                                                               :

15. No. of place required                                          :

16. Whether the applicant desires to take the plot on

       rent/hire purchase/outright sale.                             :

17.  Details or Government land with sketch map of land

       to be attached.                                                     :

18.  Plan or the proposed building for industry

       to be attached.                                                     :

19.  Remarks.                                                             :

 

 

 

       Date                                                                                     Signature of the applicant

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