Annexure 1 (For Assistance above Rs. 10.00 Lacs either by way of term loan or working capital) 1. 2. 3. 4. 5. 6.

Name of the industrial concern Name of the Promoter (S) Present Address Telephone No. Product Term loan applied for : : : : : : Rupees loan: Foreign Exchange:

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Name of the scheme under which financial assistance has been sought : (a) General scheme (b) Technician Entrepreneur /Professionally qualified (c) Physically Handicapped (d) Tiny Unit (e) Schedualed Caste /Tribe (f) Women Entrepreneurs Scheme (g) Semfex (I) Modernisation (h) Mahila Udhayam Nidhi Scheme (i) Rehabilitation (j) (k) Single Window Scheme Whether any of your relative is working in the Corporation? If so please specify the name and relationship . Whether any of the Director of the Corporation is interested in the proposal? If so ,please specify the name and relationship.

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Signature of the applicant (All the partners/Directors to sign here)

Date: (For officially use only) 1. 2. 3. 4. 5. 6. Date of receipt of application No.& date of entry in Register Whether processing fee has been received If so , amount Initial of the official Registration No. Date and time of first ABC meeting : : : : : : :

Form D Applicable to New Project, Expansion, diversification and Modernisation of of Existing Project . Does not apply to only renewal of existing Working capital facilities) 1.1 1.2 Name of the Industrial concern (in block letters) Address and Telephone Nos. Telegraphic address/Telex No. (a) Registered Office (in case of Corporate Bodies only) (b) Controlling (Head) Office (c) Factory: (existing and proposed) (d) Address for correspondence (e) Is it a backward area eligible for Concessional finance from institution/ Central/state subsidy. Constitution (a) State whether a proprietary/partnership/ Private limited /public limited concern or Co-operative society.In the case of partnership And limited companies indicate the name of Managing Partner/ Managing Director. (b) Date of incorporation /registration/comencement Of business if the unit was purchased (give details From whom and when purcbased and for what Consideration.) (c) Name of business house/group if any to Which the concern belongs and the list of Other companies in the same group.Details Of associate /subsidiary concern or concerns In which the promoters are interested. (d) Is the MRTP Act applicable to the company? If so ,you obtained the necessary clearence From the Government? Whether promoters belong to minority community viz. Sikh ,Muslim ,Christian, Zorastrian or Neo Buddhist or to SC/ST Category. Industry (a) Name of the product (s) manufactured/to be Manufactured and their uses. (b) Details of by-products,if any, and their uses. (c) Whether it is asmall scale industry, if so, Details of registration. Management Give bio-data of the main promoter including Information on name, address, age, educational Qualifications, past industrial/business experience, Experience in the particular industry, write up on Other companies, if any, promoted by him or with Which he is associated together with a copy of the Latest balance sheet ( to be furnished separately in Respect of each of the main promoters duly signed By him.) (Profoma I) ( Please enclose copies of Income-Tax Returns of the promoter along with copies of assessment orders for the last three years.) In the case of promoter is a limited company, furnish

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A write- up on the activities and past performance of The company and any other expansion programme(s)/ Diversification contempleted. Enclosure: (I) Certified copies of Memorendum And Articles of Association of the promoter company. (ii) Audited Balance Sheet and Profit And Loss Account for the past two years Of the promoter company(s) (iii) Copy of agreement(s), if any entered into The promoters. Provide a list of directors along with a complete list of Concerns with which they are connected as director, Partner, proprietor,etc. Particulers of existing key technical and executive staff Giving their names,age, qualifications, salaries, length Of service.(Proforma II). (Enclose organisation chart Showing the lines of authority.) Name(s) and address of bank(s) with whom enquiries May be made regarding the applicant concern and The promoter(s) company for bank to diecuss with The lending institution. Whether any Government enquiry, proceedings or Prosecution has been instituted against the unit or Its proprietor , promoters or directors for any offences. If so, give details. Details of pending litigation, if any, against and by The concern. Indicate whether any type of the promoters or Directors have at any time declared themselves As insolvent. 3. 3.1 BRIFE HISTORY OF THE CONCERN State briefly, the history of the unit. In case of New units state the reason for starting it. ( In Case of existing units give two copies each of Balance sheet and profit and loss accounts for The last 3 years together with comments on Adverse features of working if any. Please also Furnish proforma balance sheet and profit and Loss account as on a recent date, if the last balance Sheet is more than 6 months old.

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