General Information

1.	Type of Application (Please "b" the Appropriate Boxes)

a.	Foreign Collaboration (FC)
		   _
	For Foreign Investment	 	For Foreign Technology 

Agreements 


b.	Industrial Licence (IL)


2.	(For Office Use Only)

				      
		Application No. 
		

		Application Date

3.	Payment Details (For FCApplication No Fee is Payable. For Industrial Licences Rs. 
	2500,* is Payable)

	Draft No.	 ___________________________________


	Amount (Rs.)		


	Draft Date	 

	
	Drawn on		____________________ Payable at	_________________
				(Name of the Bank)

_______________________________________________________________________________________
*Demand Draft should be made in favour of Pay & Accounts Officer, Deptt. of Industrial
Development, to be payable at State Bank of India, Nirman Bhawan Branch, New Delhi

I.	Name and Address of the Promoter / Industrial Undertaking (Indian/foreign) in full
	(BLOCK LETTERS) forCorrespondence. 


	Name of the Promoter/Indl.	


	Undertaking 			


	Postal Address			

					


 	Pin Code 	Telephone    


	Telex			Fax 

 
	Cable		


	E-Mail		


II.	Registrarof Companies Regisration No.	 	
	(If Registered)


III.	Status of the Promoter/Industrial Undertaking

	III (1)	Status of the Promoter / Promoter Undertaking

	 1. Central Government Undertaking 		 5. Joint Sector Undertaking


	 2. State Government Undertaking		 6. Private Sector Undertaking 


	 3. State Industrial Government Corpn. 	 7.IndividualPromoter


	 4. Co-operative Undertaking		 8. Foreign/NRI/OCB Company


						 9. Foreign/NRI Individual


	III (2)Indicate whether this proposal is for (Please "b" the Appropriate Box)


		 1. Establisnment of New Undertaking / Setting up a New Company	

		 2. Effecting Substantial Expansion

		 3. Manufacture of New Articles

		 4. Amendments in existing Foreign Collaboration APproval	

		 5. Inducting Foreign / NRI equity in existing Indian Company

	IV(1)	Location of the Factory/Proposed Activities


	Address		

			


	District		


	State		


	Pin Code		Telephone	


	Telex		Fax	


	Cable		


	E-Mail		


	IV(2)		Please Indicate whether the proposed location is
			(Please "b" the Appropriate Box)

	a.	Within 25 kms from the periphery of a city havingpopulation above one 
		million according to 1991 census

		Yes			No 	

	b	If Yes , then whether it is located in an Industrial area / Industrial
		estate Designated/ set up prior to 25.7.91


		Yes			No 	

V(A).	EXISTING ACTIVITIES OF THE COMPANY(Here also specify Item codes as per National
	Industrial Classification of All Economic Activity, (NIC), 1987.

				


V(B).	PROPOSED ACTIVITIES OF THE COMPANY	

	(1)	Items of manufacture (including By-product/Co-product) proposed to be 
		undertaken (supplementary sheets may be used if necessary). 

		(a)	Item code (NATIONAL INDUSTRIAL CLASSIFICATION OF ALL ECONOMIC 	
			ACTIVITY (NIC), 1987)

					

		(b)	Item Description	

					

					

					


		(c)	Proposed Annual Capacity	

		(d)	Existing Capacity		
			(If, applicable)*

		(e) 	Total Capacity after	
 			expansion

		(f) 	Unit of capacity		

		(g)	Description of Activities to be undertaken(if no manufacturing 
			is envisaged)


(2)	Whether the Item is covered in Schedule I (Reserved for Public Sector), Schedule II
	(Under Compulsory Licensing) or Schedule III (Reserved for manufacture in the Small
	Scale Sector) of the Notification No. 477 (E) Dated 25th July, 1991

		Schedule I		Schedule II		Schedule III

		Yes			Yes			Yes	

		No.			No.			No.	

(3)	Briefly indicate process involved in manufacture of the items(s)

V(C)	Attach list of Industrial Licence/Registration/LOI/IEM acknowledgements already
	issued in favour of the applicant so far.

V(D)	Whether the Indian Promoter/Company has had a foreign collaboration earlier? If yes,
	 please specify whether for the same or similar or different products/activity. 
	Please also indicate the Approving Authority and date & No. of the Approval Letter.

V(E)	Whether the foreign /NRI/OCB collaborator has collaborations withany other
	Individual/Company in India for the same or similar or different products/activities?

	If so,please furnish / details. 

_____________________________________________________________________________________________

	Particulars of approval/Industrial Licence under which existing capacity is 
	indicated may be annexed

VI	CAPITAL STRUCTURE

(I) 	Capital Structure of Existing Indian Company(Amount in Rupees) & proposed
	capitalstructure (if revision sought)


					Equity 			Preference

	(a)	Authorised			

	(b)	Subscribed			

	(c)	Paid-up				


(II)	Pattern of share holding in Paid-up Capital (Amount in Rupees)

					Existing			Proposed

					Equity		     % 	Equity		     %

	(a)	Foreign Holding			
  					Preference  share   	Percentage

						

 	(b)	Non resident Indian Individual holding/OCB holding 
	
					Equity		     % 	Equity		     %

		(i)	Repatriable		
  					Preference  share  	Percentage

						

					Equity		     % 	Equity	                 %

		(ii)	Non-Repatriable		
  					Preference  share	Percentage

						
  					
					Equity		     % 	Equity		     %

	(c)	Resident Holding			
  					Preference  share   	Percentage

						

  	(d)	Total  II [a+b(i+ii)+c]:

			Equity			

			Preference		


VII	Proposed Borrowings (In Rupees)


	(i)	Public Financial Institution	
	(ii) 	Public Borrowing		
	(iii)	Other Sources		
	(iv)	ECB			
	(v)	Promoter Contributions	
       		Total Borrowings		

VIII. 	Please Indicate in brief:

	(i)	The background of the Indian Promotors/Company including Proprietors /
		Promotor/Directors (attach seperate sheet, if necessary)

	(ii)	The background of the Foreign/NRI/OCB Collaborator/Promoter (attach
		seperate sheet, if necessary)

IX.	Investment (in Rupees)

						Existing			Proposed

	(A)	Land					

	(B)	Building					

	(C)	Plant & Machinery				

		(i)	Indigenous			

		(ii)	Imported				

			(a)	CIF Value			

			(b)	Landed Cost		

		(iii)	Total [(i)+(ii)(b)]			

	(D)	Working Capital				

	(E)	Total Investment [A+B+C(iii)]		

X.	Export commitments / obligation which the applicant is prepared to undertake. 

    			Item Code 		
	___________________________________________________________________________________

		   Year      Units(Tonnes/ number   	Quantity   	% age of 	FOB Value
			     /meters/ any other)    			Production 	in Rupees
	___________________________________________________________________________________

		   (1)    	    	(2)       		   (3) 		    (4)  		   (5)
	___________________________________________________________________________________

	1st	    		   	 		

	2nd	    		   	 		

	3rd	    		   	 		

	4th	    		   	 		

	5th etc	    		   	 		
	___________________________________________________________________________________

	Total
	___________________________________________________________________________________

Please Indicate buy back arrangements, if any

XI.	Employment						(All Figures in 

Numbers)

					Existing		Proposed	Total
					(If applicable)

	a.	Supervisory				

	b.	Non-Supervisory				

XII.	Expected date of commencement of commercial production