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APPENDIX
14-I-A
APPLICATION FOR SETTING UP EOU/SEZs or UNITS IN SPECIAL ECONOMIC ZONE
Note:
1.
Please see Para 6.3.1 to 6.3.3 of the
Chapter 6 & Para 7.7.2 to 7.7.4 of Chapter 7 of the Handbook of
Procedures (Vol.-I).
2.
Please read the general instructions
given in EOU/SEZ Scheme before filling this application and also
some important guidelines given at the end of this application.
3.
The application may be sent
electronically or otherwise. But
the same will be treated as incomplete without its own permanent
e-mail and will not be considered.
Indicate Whether The Application Is For
AUTOMATIC APPROVAL
OR
BOARD OF APPROVAL
The
application should be submitted to the Development Commissioner of
the concerned Special Economic Zone(for setting up EOUs/units in SEZ)
in 3 copies alongwith a crossed Demand Draft of Rs. 5,000/- drawn in
favour of the Pay & Accounts Officer, Ministry of Commerce &
Industry, Department of Commerce, payable at the Central Bank of
India, Udyog Bhavan, New Delhi. (NO FEE SHALL BE CHARGED FOR RENEWEL/
EXTENSION OF LOP/ BROAD BANDING ETC.)
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
UNDERTAKING IN FULL (Block Letters)
Name of the Applicant Firm
_________________________________
Full Address
_________________________________
(Regd.Office in case of limited
_________________________________
companies & Head Office for
_________________________________
others
_________________________________
Pin Code
_________________________________
Tel. No.
_________________________________
Fax No.
_________________________________
Permanent E-Mail Address
_________________________________
Web-Site, if any
_________________________________
Passport No., if any
_________________________________
Name of Bank with Address & A/c No.
_________________________________
Digital Signature
_________________________________
Income Tax PAN
_________________________________
The name and address of each
_________________________________
Of the Director/Partner
II.
NATURE OF THE APPLICANT FIRM:
[Please tick (√ ) the appropriate entry]
Government Undertaking/Public Limited Company/Private Limited Company/
Proprietor ship/Partnership/Others (please specify)
Note:- Copy
of certificate of incorporation alongwith Article of Association and
Memorandum in case of companies and partnership deed in case of
partnership firms may please be attached.
III.
INDICATE WHETHER THIS PROPOSAL IS FOR
[Please tick (√) the appropriate entry].
Establishment
of a New Undertaking
-
Manufacturing
[ ]
-
Services
[ ]
Effecting
Substantial Expansion
Manufacturing
of New product
Conversion
of (i) existing DTA
unit into EOU/SEZ
(ii) existing STP/EHTP to EOU/SEZ
(In
case of conversion, please attach fact sheet as per Annexure)
IV.
(1)
Location of the proposed undertaking
Full Address __________________________
Pin code
__________________________
(2)
ONLY FOR PROJECTS UNDER EOU SCHEME
(In
case the unit is proposed to be located on leased premises, then
lease should be obtained from Government or any undertaking /
authority of Government. However in case lease is obtained from
private parties, it shall have a validity period of five years from
the date of LUT and the Development Commissioner shall satisfy
himself of genuine nature of the lease.)
(a)
Please indicate if the proposed location is in a Centrally
Notified Backward Area [Please tick (√) the appropriate entry].
No.
______________Yes_________________ if yes, indicate category
(b)
Indicate whether it is within 25 Kms
from the periphery of the standard urban area limit of city having
population above one million according to 1991 census.
Yes_____________
No. __________________
(c)
Is it located in an Industrial Area/Estate designated/set up
prior to issuance of Notification No. 477(E) dated 25th July,1991.
Yes_____________No.
_____________
(d)
If not, does it come under the category of non-polluting
industries as notified by the Govt.
Yes
___________ No. _______________
V.
ITEM (S) OF MANUFACTURE/SERVICE: (Including
By-product/Co-products)
(If necessary, additional sheets may be attached)
Item(s) Description
Capacity(Unit = )
tem Code(ITC HS
Code
No.)
Not required for service unit)
________________
________________
_______________________
________________
________________
_______________________
________________
________________
_______________________
VI.PRODUCTION (In case of more than one item,
supplementary sheets may be used)
Quantity (Unit __________)
(Value (In Rupees)
Not required for service unit)
1st
year
___________________
__________________
2nd
year ___________________
__________________
3rd
year
___________________
__________________
4th year
___________________
__________________
5th year
___________________
__________________
VII.
Indigenous Requirement:
(Value in Rupees)
a)
Capital Goods
b)
Raw material, components, consumables,
packing material, fuel etc. during the
period of 5 years
TOTAL:
------------------------
------------------------
VIII.
FOB VALUE OF EXPORTS
(1 $ = Rs.)
Rupees (lakhs)
US $ (Thousand)
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1st year
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2nd year
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3rd year
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4th year
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5th year
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Total:
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IX.
INVESTMENT:
(RS. IN LAKHS)
(a)
Land
________________________
(b)
Building
________________________
(c)
Plant and Machinery
________________________
(I)
Indigenous
________________________
(US $ Thousand)
(ii)
Import CIF value
________________________
(iii)
Total (I) + ii)
________________________
(d)
Details of source(s) of finance,
(both Indian as well as foreign)
for
the above investments
X.
WHETHER FOREIGN TECHNOLOGY AGREEMENT IS ENVISAGED
(Please tick ( \/ ) the appropriate entry )
Yes ____________
No_____________
(I)
Name and Address of foreign collaborator ____________________
(ii)
Terms of collaboration
(Rupees lakhs)
(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)
XI.
EQUITY INCLUDING FOREIGN 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
Total Total
1st
2nd
3rd
4th
5th (5 yrs)
In Rs./In Th
Lakhs US$
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XII.
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FOB value of exports in first
five years
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XIII.
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Foreign Exchange
outgo on
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