ANNEXURE - II 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
