GOVERNMENT OF PUNJAB DIRECTORATE OF INDUSTRIES APPLICATION FORM FOR PROVISIONAL REGISTRATION AS SMALL-SCALE INDUSTRIES (TO BE FILLED IN DUPLICATE) FORM 1. Name of unit/ applicant 2. Address for communication Telephone Pin 3. Category of unit SSI - 1, ANC - 2, SSSBE - 3 Tiny - 4, EOU - 5 4. Location Place/ town Tehsil/ taluk District State 5. Type of Organisation Proprietary - 1, Partnership - 2, Pvt. Company - 3, Cooperative - 4, Others - 5 6. Nature of activity Manufacturing/ assembling (01) Processing (02) Job Work (03) Repairing/ servicing (08) Note for any combination of activities, add the respective codes to get the required code 7. Main items of manufacture/ activities (i) Name: Code (ii) Name: Code 8. Investment in fixed assets (Rs. In '000) i) Land ii) Building iii) Plant & Machinery iv) Other fixed asset Total 9. Investment in plant & Machinery (Original value Rs. In '000) Note: Should exclude items whose value is not taken into account while computing the investment. Please enclose project profile in case value of investment in plant & machinery exceeds Rs. 40 lacs. 10. Power loan (1 H.P. + 0.795 KW) HP/KW 11. Employment: Management & Office Staff Supervisory & Workers 12. Date of commencement of Production (Estimated) Dated Signature of applicant (Authorised person) (Name of the proprietor/ partner/ managing director) FOR OFFICE USE ONLY Application no NIC Code Block Code District code State code Location of Unit. (Conforming - 1, Non-Conforming - 2) Whether the items of manufacture/ activity/ Require an industrial license. Yes -1, No - 2. (No individual license is required for items listed in schedule of the licensing notification date 25.7.1991 if the unit employee less than 50/ 100 workers with/ without power) PROVISIONAL REGISTRATION The application is accepted for provisional registration as SSI/ SSSBE unit for the manufacture of items/ activities as stated in the application form. 1. Provisional Registration No. 2. Date of issue 3. Category of unit (S. No. 3): __________________________ __________________________ 4. Name & Address of the unit: __________________________ __________________________ __________________________ 5. End products: __________________________ SIGNATURE NAME & DESIGNATION OF REGISTERING AUTHORITY 1. The endorsed application form is a part of the certificate of registration. 2. The provisional registration is valid for a period of five years from the date of issue. 3. The provisional registration will automatically lapse at the end of the validity period or the date of commencement of production, whichever is earlier. 4. If an applicant/ unit is unable to setup the unit within the validity period, the applicant/ unit has the option to apply afresh for provisional registration using standard procedure. 5. The provisional registration is given to enable the unit to obtain all facilities/ clearance etc. required in the production stage. 6. The provisional registration is subject to any or all condition that may be imposed by the registering authority. 7. Only the procurement of provisional registration certificate does not entitle you to any incentives that are otherwise admissible under the package of incentives, 1992 or any other policy of the Govt. of Punjab.
