Application Form For Setting up Infrastructural Facilities* Common application for all components. Additional requirement of each component is indicated in explanatory note below the application form. (i) Food Parks (ii) Irradiation Facilities (iii) Integrated Cold Chain (iv) Packaging Centre (v) Value Added Centre (vi) Modernization of Abattoirs *Tick mark appropriately A. Promoter 1. Name & Address (Telephone/Fax) 2. Background/Experience 3. Financial Status (Bankers Name, if any) 4. Existing Industry (If any) B. Project Description 1. Name of Project 2. Location/Area 3. Land : i. Area ii. whether in possession of implementation agency along with documentary evidence towards proof of ownership from appropriate revenue authority of the State Govt. iii. whether permitted for industrial use along with documentary evidence from appropriate revenue authority of the State Govt. 4. Technology & Machinery (source : indigenous/imported) 5. Capacity of facility (per day/per year) C. Project Cost 1. Capital Investment (Fixed capital) (a) Land Area Cost (b) Building (c) Civil works (d) Technical civil works (to be certified by Chartered Engineer/PWD) -(common facility wise) 2. Plant & Machinery (along with quotation) (Capacity/Specification/Cost) - Component wise 3. Imported Machines (along with quotation) (Capacity/Specification/Cost) - Component wise 4. Pre operative expenses 5. Working Capital 6. Raw Material / Packaging (Source/Quantity/Cost) 7. Labour (Quantity/Cost) 8. Direct & Indirect employment generated 9. Abstracts of Project cost: Item Cost (a) (b) (c) Total 77 78 D. Finance 1. Means of financing: (a) Equity : (Promoter \Foreign\Other) (b) Loan (Term/Working Capital) (c) Subsidy (along with source) (d) Fund Requirement from Ministry (MFPI) 2. Financial Benchmarks (a) Cash flow (b) Break even point (c) Internal Rate of Return (d) Debt Equity Ratio (e) Debt Service Coverage ratio E. Institutional linkages Linkages with technology/R&D/Academic institutions, agriculture universities etc. F. Linkages to Farms and Market (a) Existing Market (b) Future Demand (c) Marketing Strategy (d) Linkage to farm/backward linkages (e) Communication/market linkages G. Implementation Schedule Items of work Date of implementation (Bar charts/Milestone charts may be enclosed) H. Personnel Details of technical & managerial personnel (operation, maintenance, managerial, finance, marketing etc.) required & available. I. Attach following Documents a) Certificate of Incorporation / Registration / MOA b) Annual report / Audited statements of account for the last three year c) Detail Project Report d) Appraisal Report from a financial institution / bank e) Copy of sanction letter for term loan / working capital from Bank / FI f) Evidence of promoter's ability to bring in their contribution J. Employment Generation - Direct / Indirect Place : Dated : Signature Notes : (i) For Food Park, please indicate whether sub-division of plots for the sale/lease is permitted along with documentary evidence from appropriate revenue authority of the State Govt. No. of units proposed to be set up in the food park (Minimum 20 units) Minimum area should be 30 acre for food park (ii) For irradiation facilities Letter from BARC/AEC that technology is approved for intended process/products & copy of such letter. Technical agreement with BARC/AEC for installation & operationalisation of plant. Details of technical personnel/expertise by implementing agency showing the competence to run the operations. 79 80 (iii) For packaging centre If a packaging centre is to be setup in a food park, the requirements of other industries coming in the food park is to be worked out and packaging centre to be setup accordingly. 100% export oriented packaging centre can also be setup (iv) For integrated cold chain / value added centre Diagram of value chain and proposed intervention. Details of components of cold chain/value added centre proposed & their cost. In case some components are existing then existing & proposed should be clearly indicated. (v) For modernization of abattoirs, please indicate Facilities available in the Existing Abattoir Justification which warrant modernizing abattoirs Animals being slaughtered and would be slaughtered post modernization Existing and post modernization capacity of slaughtering Existing and post modernization Products/by-products Existing and post modernization technology Animals to be slaughtered after modernization. Whether stunning facility is available or would be available in the abattoir after modernization Project Cost 1. Capital Investment Existing Proposed for (Fixed capital) Modernization (a) Land Area Cost (b) Building (c) Civil works (d) Technical civil works 2. Indigenous imported Plant & Machinery (Capacity Specification/Cost) Existing For Modernization Working Capital & Pre-operative expenses separately envisage for the modernization Raw materials/packaging materials (source/quantity cost) Existing For Modernization Labour (Quantity/Cost) Existing For Modernization Effluent treatment disposal (Method/Machinery/Cost) Existing For Modernization Abstracts of project cost Item Cost Existing Proposed Existing Proposed Finance Means of Finance Existing Proposed Equity (Promoter/Foreign/Other) Loan (Term/Working Capital) Subsidy Fund from (MFPI)
