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Form for Provisional Registration
1. Name of the Unit/Applicant.

2. Address for communication.

Tel:

Pin Code:

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

6. Nature of activity

Manufacturing/Assembly (01)

Processing (02)

Job work (04)

Repairing/Servicing (08)

Note: For any combination of activities, add the respective code 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 & Machinery

iv) Other Fixed Assets

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 and Machinery exceeds Rs.40 lacs.

10. Power Load H.P.

(1 H.P. = 0.795 K.W) K.W.

11. Employment

i) Management & 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

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 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)