SSI-Pmt Serial No. GOVERNMENT OF TRIPURA DIRECTORATE OF INDUSTRIES APPLICATION FORM FOR PERMANENT REGISTRATION AS SMALL SCALE INDUSTRIES (TO BE FILLED IN TRIPLICATE) INSTRUCTIONS 1. Write/type in block(capital) letters. 2. Fill up whichever is applicable. 3. Use English alphabets/Arabic numbers while filling up blocks (to help computerization).Leave one blank after each word. 4. Name of unit e.g. KAMAL ENTERPRISES/G.K.ENTERPRISES i) Name of unit e.g. KAMAL ENTERPRISEES/G.K.ENTERPRISES K A M A L E N T E R P R I S E S G. K. E N T E R P R I S E S ii) PIN Code :e.g.110041 iii) Date e.g.23rd June 1959 iv) Quantity (Kg)e.g. 90Kg v) Amount (Rs.in thousands)e.g.Rs.5000/= vi) vii) Fill up appropriate codes in the blocks wherever applicable. Example 1:Yes-1No.-2 NA-3. If Na fill up-3. Example 2:Category:SSI-1,Anc-2, Tiny-3,SSSBE-4, EOU-5 If Tiny fill up-3 5. Block / boxes marked (*) are to be filled by office. 6. Applicant should sign all copies. Abbreviations SSI : Small Scale Industries. ANC : Ancillary Industrial undertaking. SSSBE : Small Scale Service and Business Enterprise. TINY : Tiny Enterprise. EOU : Export Oriented unit. NA : Not applicable 1 1 9 3 0 0 1 4 6 0 2 5 9 0 0 0 0 0 5 0 0 0 0 3 3 FORM 1. Provisional Registration No. 2. Date of Issue. 3. Date of Commencement of production. 4. Name of Unit/Applicant. 5. Address for communication. TEL: 6. Category of Unit. SSI-1, ANC-2, SSSBE-3, TINY-4, EOU-5. 7. Location. Place/Town Tahasil/Taluk District State 8. Area of Location. Rural-1, Urban-2, Metropolitan-3 9. Type of organization Proprietory-1,Partnership-2,Pvt.company-3, Cooperative-4,Others-5. 3 2 10. Nature of activity Manufacturing/Assembly (01) Processing (02) Job work (03) Repairing/Servicing (04) 11. Main items of manufacturing/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 and Machinary iv) Other fixed assets TOTALS : 13 Investment in plant and Machinery. (original value Rs.in .000) (Details to be furnished at Appendix'B') 14. Raw material requirement. Name *Item Code Imported-1 Annual Consumption Indigenous-2 value (Rs.in.000) (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-conventional energy-16, Traditional energy/Firewood-32 16. Power Load (1H.P=0.795 K.W) H.P K.W. 17.Employment. (i) Manegerial &Office Staff (ii) Supervisory and Workers 18.Whether Registered under Factories Act Yes-1 No-2 19.Applicant's Profile Male-1 Female-2 SC-1 ST-2 Engineering Graduate-1 Other Graduate-2 Others-3 Signature of Applicant Date Name of Proprietor/Partner/ Manager Director FOR OFFICE USE ONLY Application No. NIC Code Block Code District 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 licensing notification dated 25/7/1991 if the unit employs less than 50/100 workers with/without power) CERTIFICATE OF REGISTRATION The unit is permanently registered as a SSI/SSSBE unit for the manufacture of items/activities as stated in the application form and briefly noted below: Item of manufacture/activity(S.No11 &Appendix-A) 1. 2. 3. 4. 5. Investment in plant and Machinery(S.No13 & Appendix-B) Rs.in .000 Permanent Registration No: Date of Issue: Category of unit(S.No.6): FOR TINY ENTERPRISES : The unit is a tiny enterprise and its status as "tiny enterprise" is valid upto. Validity is extended upto Validity is extended upto Date : Signature : Name &designation of Registering Authority 1.The endorsed application form is a part of the certificate of registration. 2.The certificate is valid for the items of manufacture/activity noted at S.No.11 and Appendix A and is also valid for any other item/activity undertaken by the unit. 3.Conferment of the status as atiny enterprise is to be validated/renewed every five years as per procedure prescribed. 4.The certificate is subject to the affidavit furnished by the applicant in respect of the application for registration. 5.The certificate is subject to any or all the condition that may be imposed by the Registering Authority. 6.If at any time it is found that the declaration/affidavit furnished by the applicant is not true or in the event of violation of any of the conditions imposed by the registering authority,or if the investment exceeds the prescribed limit,the registration certificate is liable to be cancelled/ quashed without any prior notice. 7.This certificate does not confer or accrue any right to the applicant and cannot be treated as proof in respect of any statutory requirement or condition that may exist under any law for the time being inforce.The onus of satisfying and fulfilling such requirements or conditions rests squarely on the applicant/unit. 8.Additions/deletions in the list of Plant of Machinery and the revised investment value thereof and /or any changes in the constitution of location of the unit should be made in the additional sheets appended to the certificate on the request of the applicant. CERTIFICATE OF REGISTRATION ADDITIONAL SHEET-1 Registration no. Date of issue. Addition/deletion in Plant & Machinery S.No. Name of Machinery Added/deleted Original value Rs.in.ooo 1. 2. 3. 4. 5. Revised value of investment in Plant & Machinery(S.No.14) (Rs.in .000) Change in location (S.No.7) Change in constitution/type of organization : (S.No.9) Signature : Date : hhhhhhhhhhhhhhhh Name & designation Of Registering Authority ::9:: Appendix A For any combination add the respective codes (Value in Rs.'.000') Sl Products & by-products Product Unit Unit Annual No. manufactured/assembled Code* Quantity* Code* Quantity Value & services sold 1 2 3 4 5 6 7 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) 11 Total (7 to 10) X X X X 12 Job work X X X 13 Servicing X X X 14 Repairing X X X 15 Total (12 to 14) X X X X 16 Grand Total(6+11+15) X X X X APPENDIX--B ::10:: Details of Plant and Machinery Sl. Name of the Machinery No. Imported-1 Cost (original value) Indigenous-2 Rs.n.000 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
