Industral Infrastructure Development Corporaton Block DJ, Plot No. 10, Sector II, Saltlake Cty, Kolkata 700 091 APPLICATION FORM FOR ALLOTMENT / ASSIGNMENT OF PLOT OF LAND / SHED / SDF BLDG. IN INDUSTRIAL GROWTH CENTRE / PARK [Please Submt the applcaton n trplcate n terms of the nstructons] I/We hereby apply for allotment/assgnment/transfer of land/shed/sdf Buldng for settng up ndustral unts/housng purpose/assgnment/shed measurng acres/ Sq. ft. modules/unts n WBIIDC's Industral Growth centre / Park. I/We hereby submt the followng nformaton so far as t relates to my/our ndustry as under. 1 Name of the applcant/frm/company 2 Address of regstered offce wth Telephone No., Fax No., E-mal ID and webste address 3 State whether t s (ownershp type) : v v v Propretory Partnershp Prvate Lmted Publc Lmted Jont Venture Co-operatve Socety 4 Nature of Project/Industry [Attach Detal Project Report alongwth Plant layout arrangement drawngs both n soft and hard fle(n duplcate) for Techno-Economc evaluaton]. 5 Requrement of Land/Shed/SDF Flat (In acres/sqm./no. of Unts of SDF, Shed) [Break up to be gven as per plant layout arrangement] a. Total area covered by Buldng/Factory/Sheds etc. b. Any area necessary for open storage (to be shown n Plant Layout Drawng) c. Any area necessary for future expanson (to be shown n Plant Layout Drawng) Total Area (In acres)
Industral Infrastructure Development Corporaton Block DJ, Plot No. 10, Sector II, Saltlake Cty, Kolkata 700 091 6() Proposed Products of manufacture ndcatng annual Capacty Engneerng tem Chemcal Item Others Nature & Qnty. Of Effluent (Vol /day) 6() Product Detals and Bye-Products, f any 7 whether proposed Project comes under small /medum /large scale ndustry 8 CAPITAL OUTLAY (Rs. In Lakhs) To commence producton To acheve Proposed Capacty of Producton Land & Buldng Plant & machnares Other Fxed Assets v Workng captal v Contngences Total 9 MEANS OF FINANCING (Rs. In lakhs) 10 Promoter's Equty Insttuton's Equty Term loan v Subsdy v Others Total Whether any fnancal Insttuton / Bank approved your project for fnancng. If yes, please enclose the photocopy of the letter. 11 Antcpated tme (to be reckoned from the date of delvery of possesson of land) a b c For constructon and nstallaton of plant & machnares For commencng producton To reach the proposed producton capacty Months Months Months
Industral Infrastructure Development Corporaton Block DJ, Plot No. 10, Sector II, Saltlake Cty, Kolkata 700 091 12 EMPLOYMENT POTENTIALITIES To commence producton To acheve the Rated / Lcensed Capacty of Producton Techncal v v Manageral Supervsory Non-supervsory Sklled Un-Sklled Non- Techncal Manageral Supervsory Non-supervsory a Sklled b Un-Sklled Total 13 REQUIREMENTS OF INFRASTRUCTURE FACILITIES OR AMENITIES at Constructon Stage At Commencement of Producton To acheve rated/lcenced Water (Ltre/day) Power (KW/KVA Any other facltes and/ or amentes 14() Does the proposed project nvolve polluton of water / ar n any way? 14() Please ndcate whether N.O.C. receved from / appled to West Bengal Polluton Control Board. (Attach relevant documents) 15 Please attach photocopes of the regstraton no. of the Frm / Company 16 Foregn collaboratons, Jont Sector, f any, please affx name & address of the Collaborator & other detals n bref.
Industral Infrastructure Development Corporaton Block DJ, Plot No. 10, Sector II, Saltlake Cty, Kolkata 700 091 17 Any other relevant nformaton the applcant lkes to furnsh Date : Sgnature : Enclosures : 1 2 3 4 5 Declaraton I, son / daughter of resdng at, the propretor / one of the partner / Drectors of the applcant frm / Company do hereby declare that the statements made and nformaton dsclosed n the applcaton and the enclosures sent herewth sgned by me are true to the best of my nformaton and belef. If, however, any statement or nformaton dsclosed n the applcaton and the enclosures sent herewth are found to be untrue, the allotment and / or lease granted n persuence to ths applcaton shall be deemed to have been procured fradulently and consequents of such procurement of allotment / lease wll be dealt wth by the Corporaton n accordance wth the law. Any change / modfcaton / varaton n any of the nformaton dsclosed / change of consttuton of the Company / frm wll be communcated to the Corporaton at the earlest along wth supportng documents. Sgnature n full Place : Date: Desgnaton & Seal of Offce
Industral Infrastructure Development Corporaton Block DJ, Plot No. 10, Sector II, Saltlake Cty, Kolkata 700 091 PARTICULARS OF PROMOTER / DIRECTOR To be submtted wth applcaton for allotment of land n WBIIDC Industral Growth centre. Please use extra sheet for for each Promoter / Drector. 1 2 Name of the Unt : Bo data of Promoter / Drector Name Age Address v Phone No. Offce : Resdence : v Fax No v E-Mal ID : Organsaton: @ Self : @ v Academc Qualfcaton v Professonal/Work Experence Year Employer Desgnaton Functonal Dutes Salares Drawn 3 Functonal Responsbltes n the Unt 4 Equty / Loan contrbuton n the unt : 5 If assocated as Propretor / Drector / Shareholder wth Concerns other than n the Applcant unt, please gve detals.
Industral Infrastructure Development Corporaton Block DJ, Plot No. 10, Sector II, Saltlake Cty, Kolkata 700 091 Instructons The applcant s requred to submt the followng documents as applcable : 1a. In case of Publc / Prvate Lmted Company / Jont Venture Company Photocopes of Certfcate of Regstraton alongwth Memorundum of Assocaton & Artcle of Assocaton and Balance sheet A bref Statement showng name of the Drectors, ther respectve shareholdng, term of offce, PAN, DIN etc. 1b. In case of Partnershp frm : Name and address of each Partner Certfed Copy of Certfcate of regstraton of Frm Copy of Partnershp Deed 1C. In case of Co-operatve Socety Regstraton Certfcate and Bye Laws 1d. In case of Foregn Collaboraton / JVC Agreement duly approved by Govt. of Inda: Approval Certfcate Certfcate of Regstraton of the Company 2 Audted annual accounts and annual report for last three years perod 3 Detaled Project report (n duplcate) contanng organsatonal, techncal, Market, fnancal, economc & envronmental analyss and plant layout drawng justfyng requrements of desred quantty of land. Soft fles of the report n MS word (for text materals), MS Excel (for fnancal computatons) and AutoCAD (for plant layout drawng) are to be submtted for techno-economc feasblty evaluaton of submtted project report. Relevant specfc nformaton requred n course evaluaton are also to be suppled. 4 Updated Income Tax Clearance Certfcate [If any document s not readly avalable, please ndcate the posble date of avalablty of such documents.]