ANNEXURE - IV(A)

 

To download the form   

Click Here   

GOVERNMENT OF ORISSA

DIRECTORATE OF INDUSTRIES

APPLICATION FORM FOR PERMANENT REGISTRATION AS

SMALL SCALE INDUSTRIES

(TO BE FILLED IN TRIPLICATE)

 

1.   Provisional Registration No.                       :

2.   Date of Issue                                              :

3.   Date of Commencement of Produciton       :

4.   Name of Unit/Applicant                              :

5.   Address for communication                        :             

                      At.   :

                      PO    :

                      Dist. :

                      Tel   :

                      Pin   :

 

6.   Category of Unit                                          :

      SSI-1,  ANC-2,  SSSBE-3, TINY-4,  EOU-5

 

7.   Location       :                 Place/Town           :

                                           Tahsil/Taluk           :

                                           Distict                    :

                                           State                      :

8   Area of Location                                           :

     Rural01,  Urban-2,  Metropolitan-3                     

 

9.  Type of Organisation                                     :

     Proprietory-1,  Partnership-2,   Company-3

     Co-operative-4,  Others-5

10.Nature of activity                                           :

     Manufacturing/assembling         (01)

     Processing                               (02)

     Job work                                 (04)

     Repairing/Servicing                   (08)

11.Main items of manufacture/activities                :

     (details of capacity to be furnished in Appendix-A)

          i.     Name                      :

                 Code                       :

          ii.     Name                      :

                 Code                       :

          iii.    Name                       :

                 Code                       :

          iv.    Name                       :

                  Code                      :

           v.    Name                      :

                  Code                      :

12.Investment in Fixed Assets (Rs. In '000)

                i..  Land                         :

                ii.  Building                    :

                iii. Plant & Machinery     :

                iv. Other Fixed Assets    :

                     Total                         :

 

13.Investment in Plant & Machinery

     (Original Value Rs.'000)

     (Details to be furnished at Appendix 'B'      :

14.Raw Material requirement                           :

 

           Name            item Code                          Imported-1                              Annual Consumption

                                                                      Indigenous-2                             Valu (Rs. in 000.00)

 

       i.              

       ii.

       iii.

       iv.

       v.  Other raw materials

                Total (i. to v.)

 

15.Source of Power                                                :

     Coal-01,  Oil-02,  LPG-04,  Electricity - 08

     Non-convention energy-16, Traditional energy.

     Fire Wood-32.

 

16.Power Load,                         HP

     (1 H.P.=0.795Kw)                 Kw

17.Employment.

                (a)   Managerial & Office Staff                 :

                (b)   Supervisory and Workers                 :

18.Whether Registered under Factaries Act

                Yes-1                                       No-2

19.Applicant's Profile

                Male-01                                   Female-2

                SC-01                                       ST-02

                Engineering Graduate-1,   Other Graduate-02

                Other - 03.

Date:

                                                                                        Signature of Applicant

 

                                                                 

                                                                  Name of Proprietor/Partner/Managing Director.

 

 

 

FOR OFFICE USE ONLY

 

 

Application No.    :                                 NIC Code.:                             Block Code.:

Distric Code          :                                 State Code:

 

Whether the items of manufacture/activity require

an industrial licence. Yes-1,  No-2.

 

(No Industrial licence is required for items listed in schedule II of the licencing notification dated 25-07-1991 if the unit employs less than 50/100 workers with/without power.

 

ANNEXURE - IV(B)

CHECK LIST

DOCUMENTS SUBMITTED ALONGWITH THE APPLICATION FORM FOR PERMANENT REGISTRATION.

(TICK OUT)

1.   Photostat copy of the documents proving legal ownership or lease of the land on which the unit is  established.

 

2.   Copies of vouchers - all plant and machineries.

 

3.   Certified list of all plant and machinery including installation, electrification, Generator,            

Transformer, Tools, Zigs, Moulds, dies indicating specification and cost of each in possession of  the  owner and any other unit under the same ownership signed by the owner.

 

4.   Copy of agreement with OSEB. Clopy of Energisation certificate i.e. date of line charged and  first   Electric bill.

 

5.   Copy of statutory licence of permission from appropriate authority (Municipality, NAC, Cinema  Hall, Explosive Licence drug licence, Cold storage, no objection certificate from SPCP Board          etc.

 

6.   Copy of Original PRC.

 

7.   Copy of sanction letter from financial Agency.

 

8.   Copy of article of assiciation and incorporation certificate from Joint Stock Company or             

partnership deed for partnership firm.

 

9.   Copy of first purchase raw material bill.

 

10.  Two Passport size photograph of promoter.

 

11.  Certified that I will show original vouchers and documents to the verifying Officer at the time of  inspection.

 

                                                   Signature of the applicant                             official seal.

Date

APPENDIX-A

For any combination and the respective codes                                                      (Value in Rs. '000)

Sl    Product & by-products         product             unit of              Unit            Annual                 Capacity

No.  manufactured/ assmbled         code               quantity           code          quantity                 value

       & service sold

--------------------------------------------------------------------------------------------------------

01.  Manufacturing/assembly

02.      

03.      

04.      

05.  Other Prd, & by-prd(comb)

06.  Total (1 to 5)                             X                           X                    X               X                        X

07.  Processing

08.      

09.      

10.  Others(Combined)                                                      X                 X               X

11.  Total (7 to 10)                           X                               X                 X               X

12.  Job Work                                                                    X                 X              X

13.  Serviving                                                                      X                 X              X

14.  Repairing                                                                      X                 X              X

15.  Total (12 to 14)

APPENDIX - B

DETAILS OF PLANT AND MACHINERY

Back

~~*~~