GOVERNMENT OF TRIPURA DIRECTORATE OF INDUSTRIES SMALL SCALE INDUSTRIES (TO BE FILLED IN DUPLICATE) 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 iii) Date e.g. 23rd June 1959 2 3 0 6 5 9 iv) Quantity (Kg) e.g. 90 Kg 0 0 0 0 9 0 0 0 0 0 5 v) Amount (Rs in thousands) e.g. Rs.5000/= 3 3 Example 2. : Category : SSI-1.,Anc-2 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 Abbreviations used : 5.Block/boxes marked (*) are to be filled by office. 6.Applicant should sign all copies. APPLICATION FORM FOR PROVISIONAL REGISTRATION AS 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. i) Name of unite e.g. KAMAL ENTERPRISES / G.K.ENTERPRISES 4.While filling the form, use the following procedure : 1 Example 1. : Yes-1 No.-2 NA-3. If Tiny fill up-3 ii) Pin Code : e. g. 110041 vi) Fill up appropriate codes in the blocks where ever applicable. EQU-5 Tiny-3,SSSBE-4, Proprietory -1, Partnership-2, Pvt. Company-3, Tripura 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 5.Type of Organization. 6. Nature of activity. Note : For any combination of activities, add the respective codes to get the required code. Tehsil/Taluk District State Cooperative-4, Other-5 Job work (04) Processing (02) Repairing/Servicing (08) Manufacturing/assembly (01) Any other values entered except those mentioned in No. 6 i.e, "Nature of Activity" will make the form liable to useless. i) Name : Code : ii) Name : Code : iii) Name : Code : iv) Name : Code : v) Name : 8. Investment in Fixed assets (Rs. In.000). i)Land ii)Building iii)Plant and Machinery iv)Other fixed assets Total :- 7.Main items of manufacture/activities. 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. 9.Investment in Plant and Machinery (Original Value Rs. in.000) Code : Name of Proprietor/Partner/Managing Director 10. Power load HP (1 H.P.=0.795 KW) KW 11. Employment : i) Number of Managerial & Office staff : ii) Number of Supervisory and Workers : 12 Date of commencement of production Date : (estimated) Signature of Applicant Authorised person
