1.

Name and address of the Unit

(a)    Telephone No.

(b)    Fax No./Telex No.

2.

Constitution

3.

Background of the Company along with details of co-business if any for last 3years

4.

Bio-data &Background of the Promoters with details of net worth

5.

Source for mobilization of funds and investment already made

6.

Location

7.

Item of Manufacture

(a)    Existing

(b)    Proposed

8.

Status of the Project Expansion Project/ Modernisation Project Diversification Project EOU

9.

Cost of the Project           (Rs. in lakhs)

Means of finance               (Rs. in lakhs)

(a)   Land & Building     :

(a)   Promoters Equity    :

(b)   Plant & Machinery  :

(b)   Institutions Equity   :

( c)   Others                     :

( c)  Term Loan              :

(d)    Contingency           :

(d)    Others:

         TOTAL                  :

         TOTAL                  :

10.

Details of Foreign Technology/ Financial Collaboration, if any

11.

OST/CST generation (Rs. in lakhs)

(a)    Existing

(b)    Proposed

12.

Ancillary Development

13.

 Employment Generation

(a)     Existing

(b)     Proposed

14.

Building Details (Sq. Mt.)

(a)    Existing built up area 

(b)   Proposed built up area     (Sq. Mt.)

        (i)      Office                 :

(i)     Office                   :

        (ii)     Factory               :

(ii)    Factory                 :

                  TOTAL             :

TOTAL                :

15.

Power

(a)    Connected Loan (in KVA)

         (i)      Existing       :

         (ii)     Proposed      :

(b)     Contract Demand (in KVA)

          (i)     Existing       :

          (ii)    Proposed      :

16.

Water (Qty. in liters per day)

(i)     Existing       :

(ii)      Proposed      :

17.

Details of the permission/licence/ sanction/obtained already

18.

Proposed date of Commercial Production

19.

Assistance sought from the IPICOL

(1)   Land

(2)   Water

(3)   Power

(4)   Pollution Control Board                   Clearance

(5)   Others

20.

Recommendations

(1)   Land

(2)   Water

(3)   Power

(4)   Pollution Control Board Clearance

(5)Others (Incentives & Concessions)