GOVERNMENT OF TRIPURA DIRECTORATE OF INDUSTRIES APPLICATION FORM FOR PROVISIONAL REGISTRATION AS SMALL SCALE INDUSTRIES (TO BE FILLED IN DUPLICATE) 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 computerisation). Leave one blank after each word. 4. While filling the form, use the following procedure : i) Name of unite e.g. KAMAL ENTERPRISES / 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 1 1 0 0 4 1 ii) Pin Code : e. g. 110041 ii) Date e.g. 23rd June 1959 2 3 0 6 5 9 iii) Date e.g. 23rd June 1959 0 0 0 0 9 0 iv) Quantity (Kg) e.g. 90 Kg 0 0 0 0 5 v) Amount (Rs in thousands) e.g. Rs.5000/= vi) Fill up appropriate codes in the blocks where ever applicable. 3 Example 1. : Yes-1 No.-2 NA-3. 3 Example 2. : Category : SSI-1.,Anc-2 Tiny-3,SSSBE-4, EQU-5 If Tiny fill up-3 5. Block/boxes marked(*) are to be filled by office. 6. Applicant should sign all copies. Abbreviations used : SSI : Small Scale Industries ANC : Ancillary Industrial undertaking SSBE : Small Scale Service and business enterprise TINY : Tiny Enterprise EOU : Export Oriented Unit NA : Not Applicable. GREEN : Applicant WHITE : DIC Copy FORM 1. Name of Unit/Applicant. 2. Address for Communication. TEL: 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 Organization. Proprietory -1, Partnership-2, Pvt. Company-3, Cooperative-4, Other-5 6. Nature of activity. Manufacturing/assembly (01) Processing (02) Job work (04) 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 : iii) Name : Code : iv) Name : Code : v) Name : Code : 8. Investment in Fixed assets (Rs. In.000). i)Land ii)Building iii)Plant and Machinery iv)Other fixed assets Total :- 9. Investment in Plant and 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 and Machinery exceeds Rs. 40 lacs. 10. Power load HP (1 H.P.=0.795 KW) KW 11. Employment : i) Managerial & Office staff ii) Supervisory and Workers 12 Date of commencement of production (estimated) Date : Signature of Applicant (Authorised Person) Name of Proprietor/Partner/ Managing Director
