(The Appendix 16-J has been added as per the Annexure-III to the
PN No. 37/(RE-00)/1997-2002 Dated 09/10/2000)
Appendix 16 J
Note : 1. Please see Paragraph 9.2 of this Handbook.
The application should be submitted to the Development Commissioner of the concerned Special
Economic Zone (SEZ) for setting up units in SEZ, in 5 copies along-with a crossed Demand Draft
of Rs. 1,000/- (Rupees 2,500/- in case of items falling under Schedule I & II of the New
Industrial Policy) drawn in favour of the Pay & Accounts Officer, Department of Industrial
Development, payable at the State Bank of India, Nirman Bhavan, New Delhi
______________________________________________________________________________________________
For Official Use only
Application No. _____________________
Date : ___________________________
Date _____ Month _____ Year _______
--------------------------------------
______________________________________________________________________________________________
Details of Bank Draft
Amount Rs. ________________
Draft No. ________________
Draft Date ________________
Drawn on ________________
(Name of the Bank)
Payable at ________________
I. Name and Address of the Promoter (Block Letters)
Name of the company/Applicant ______________________________
Full Address ______________________________
(Regd. Office in case of limited companies ______________________________
& Head Office for others ______________________________
______________________________
Pin Code ______________________________
Tel. No. ______________________________
Fax No. ______________________________
E-Mail No. ______________________________
II. Nature of the Applicant Firm:
(Please tick (ü) the appropriate box)
1. Government undertaking
2. Public Limited Company
3. Private Limited Company
4. Proprietorship
5. Partnership
6. Others (please specify)
III. Indicate Whether this Proposal is for
(Please tick (ü) the appropriate box)
1. Establishment of a New Undertaking, for manufacturing/Trading/Service
2. Effecting Substantial Expansion of the approved activity.
3. Manufacture of New product or for new service or trading.
Please furnish the following in case of manufacturing unit:
IV. Item(s) of Manufacture : (Including By-product/Co-products)
(If necessary, additional sheets may be attached)
Item(s) Description Capacity (Unit = ) Item Code (ITC HS Code No.)
______________________ ______________________ ______________________
______________________ ______________________ ______________________
______________________ ______________________ ______________________
Please furnish the following in case of trading/service unit:
(Rs. in lakhs)
| V. | Indicate Broad Details of the Products/Service activities for Which Unit is Proposed in a Period of Five Years | Imports | Export | Local purchase | |
| | | | | | |
VI. FOB Value of Exports
(1$ = Rs.)
| | Rupees (lakhs) | US $ (Thousand) |
| 1st year | | |
| 2nd year | | |
| 3rd year | | |
| 4th year | | |
| 5th year | | |
| Total | | |
VII. Investment: (Rs. In Lakhs)
(a) Land ________________________
(b) Building ________________________
(c) Plant and Machinery ________________________
(I) Indigenous ________________________
(US $ Thousand)
(ii) Import CIF Value ________________________
(iii) Total (I) + (ii) ________________________
VIII. Whether Foreign Technology Agreement is envisaged (please tick (ü) the appropriate box)
Yes _____________ No _____________
(I) Name and Address of foreign collaborator _________________________
(Rupees lakhs)
(ii) Terms of collaboration
(Gross of Taxes)
(a) Lumpsum payment ________________
(b) Design & Drawing fee ________________
(c) Payment to foreign technician ________________
(d) Royalty (on exports) ________________%
(e) Royalty (on DTA sales if envisaged) ________________
(f) Duration of agreement ________________
(No. of years)
IX. Equity including Foreign/NRI Investment
(i)
($ Thousand) (Rs. lakhs)
(a) Authorized ________________ ________________
(b) Subscribed ________________ ________________
(c) Paid up Capital ________________ ________________
Note : If it is an existing company, please give the break up of the existing and proposed
capital structure
(ii) Pattern of share holding in the paid up capital (Amount in Rupees)
(Rs. in lakhs) (US $ Thousand)
(a) Foreign holding ________________ ________________
(b) Non Resident Indian company/Individual holding
________________ ________________
(i) Repatriable ________________ ________________
(ii) Non-repatriable ________________ ________________
(c) Resident holding ________________ ________________
(d) Total (a+b(i+ii)+c equity) ________________ ________________
(e) (iii) External commercial Borrowing _______________ ________________
Foreign Exchange Balance sheet
$
| | | 1st | 2nd | 3rd | 4th | 5th | Total 5 Yrs | |
| X. | FOB value of exports in first five years | | | | | | | |
| XI. | Foreign Exchange outgo on | | | | | | | |
| (i) | Import of machinery | | | | | | | |
| (ii) | Import of raw materials and components | | | | | | | |
| (iii) | Import of spares and consumables | | | | | | | |
| (iv) | Repatriation of dividends and profits to foreign collaborators | | | | | | | |
| (v) | Royalty | | | | | | | |
| (vi) | Lump sum know-how fee | | | | | | | |
| (vii) | Design and drawing fee | | | | | | | |
| (viii) | payment of foreign technicians | | | | | | | |
| (ix) | Payment on training of Indian technicians abroad. | | | | | | | |
| (x) | Commission on Export etc. | | | | | | | |
| (xi) | Foreign Travel | | | | | | | |
| (xii) | Amount of interest to be paid on external commercial borrowing/deferred payment credit (specify details) | | | | | | | |
| (xiii) | Any other payments (Specify details) | | | | | | | |
| | Total (i) to (xiii) | | | | | | | |
| | Net Foreign Exchange earnings in five years | | | | | | | |
XII. REJECTS
Generation of Rejects/Sub-standard __________________________ goods of the finished
________________________ _______________________________
(percentage of 5 yrs
production)
XIII. SUB-CONTRACTING
a) Whether any of the required components are -------------- --------------
proposed to be sub-contracted to small scale -------------- --------------
and ancillary units. Yes No
XIV. EMPLOYMENT
(All figures in number)
Existing Proposed
------------------- -----------------------
a) Supervisory ----------------------- -----------------------
b) Non-supervisory ----------------------- -----------------------
XV. NET FOREIGN EXCHANGE EARNING
Percentage
Positive Foreign Exchange earning in five year in terms -----------------------
of paragraph 16.4 of the policy -----------------------
XVI. MARKETING
a) Whether marketing tie-up/Buy-back envisaged/ -------------------- ---------------
finalized?(Attach documents, if any) --------------------- ---------------
Yes No
G.C.A. R.P.A.
----------------- ---------------
b) Destination of exports (in percentage)
XVII. OTHER INFORMATION
| i) | | Any special features of the project proposal which you want to highlight | ------------------------------------------------------------ |
| | | (please attach the project report, for new units) | ------------------------------------------------------------ |
| ii) | (a) | Whether the applicant has been issued any industrial license or LOI/LOP under EOU SEZ/EPZ scheme if so, please give full particulars especially reference number, date of issue, items of manufacture and progress of implementation of each project. | ------------------------------------------------------------------------------------------------------------------------------------------------------ |
| | (b) | Whether the applicant has submitted any other application for LOI/LOP which is pending. If so, please give particulars like reference number, name under which application made, items of manufacture etc. | ------------------------------------------------------------------------------------------------------------------------------------------------------ |
| (iii) | | Whether the applicant or any of the partners/Directors who are also partners/Directors of another company or its associate concerns have been debarred from getting any License/Letter of Intent/Letter of Permission under the Export and Import (Control) Act, 1947/Foreign Trade (Development and Regulation) Act, 1992 or otherwise penalized. | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
Place :___________ Signature of the Applicant
_________________________
Date:___________ Name in Block Letters
_________________________
Designation________________
Official Seal/Stamp___________
Full Official Address : ...............................
...............................
Full Residential Address : ...............................
...............................
UNDERTAKING
I/We hereby declare that the above statements are true and correct to the best of
my/our knowledge and belief. I/we will abide by any other condition which may be stipulated by
the concerned Development Commissioner of Secretariat of Industrial Approvals (Deptt. of
Industrial Policy and Promotion). I/We fully understand that any Permission Letter granted to
me/us on the basis of the statement furnished is liable to cancellation or any other action
that may be taken having regard to the circumstances of the case if it is found that any of
the statements or facts therein are incorrect or false.
Signature of the Applicant :.............................
Name in Block Letters ..............................
Designation :.............................
Official Address :.............................
..............................
..............................
Residential Address :.............................
..............................
..............................
Place:__________
Date:__________