application form for approval of projects by st ate … · 2017-07-03 · application form for...

GOVERNMENT OF KARNATAKA

DIRECTORATE OF INDUSTRIES & COMMERCE

2nd FLOOR, KHANIJA BHAVAN (SOUTH WING)

NO. 49, RACE COURSE ROAD,

BANGALORE - 560 001. INDIA.

TEL: 91-80-22386796

FAX: 91-80-22389909

APPLICATION FORM

FOR APPROVAL OF PROJECTS BY

STATE HIGH LEVEL CLEARANCE COMMITTEE/

STATE LEVEL SINGLE WINDOW CLEARANCE COMMITTEE

KARNATAKA UDYOG MITRA

(A Government of Karnataka Organisation)

3rd Floor, Khanija Bhavan(East Wing),

No. 49, Race Course Road, Bangalore - 560 001. India.

Tel: 91-80-22282392/22285659/22286632 Fax: 91-80-22266063

Website:kum.karnataka.gov.in

POWERS OF STATE HIGH LEVEL CLEARANCE COMMITTEE (SHLCC) / STATE

LEVEL SINGLE WINDOW CLEARANCE COMMITTEE (SLSWCC)

(AS PER KARNATAKA INDUSTRY (FACILITATION) (AMENDMENT) ACT - 2013)

State Level Single Window Clearance Committee (SLSWCC):-

. The State Level Single Window Clearance Committee examines and accord in principle

approval for any industrial and other projects to be set in a state with an investment more than

Rs. 15.00 Crores and less than Rs. 500.00 Crores each (15crores < 500crores).

State High Level Clearance Committee (SHLCC):-

The State High Level Clearance Committee examines and accord in principle approval for any

Industrial and Other Projects to be set in the State with an investment of Rs. 500.00 Crores and

above in each case.

INSTRUCTIONS/CHECK LIST

1. The instructions for online application filing, checklist for documents to be attached,

processing fee for obtaining in principle approval, are available in the e-Udyami portal i.e.

http://kum.karnataka.gov.in/ or http://ebizkarnataka.gov.in/

http://kum.karnataka.gov.in/

http://ebizkarnataka.gov.in/

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1. User Id

Name Of the Company / Unit

Country of Origin if MNC

Correspondence Address

Pin Code

Telephone No.

Fax No.

Email

Mobile

Corporate / Office Address

Pin Code

Telephone No.

Fax No.

Email

Mobile

Name of the Managing Director /

CEO / Chief Promoter / Trustee /

Managing Partner / Proprietor

Land Line :

Contact details (above) Mobile :

Email :

Name of the Authorized

Coordinating Person

Land Line :

Contact details (above) Mobile :

Email :

2. Whether the project is

considered under Global

Investors Meet?. If so

furnish details

Whether the project possessing 3.

IEM (Industrial Entrepreneurship Memorandum Acknowledgement)?.

4. Details of Processing Fee Paid

Payment By :

5. Status of the Company/Unit Undertaking

: Details of registration :

6. Category of the entrepreneur

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7. Financial Indicators of the Company / Firm / Associated Companies etc (Last 3 Years in Rs.Crores)

Year Turn Over Profit Before Tax Net Worth Reserves & Surplus Share Capital

Name of the company for which above

information provided and also relationship :

with the subject company

8. Company Proposal :

9. Background of the Company :

Year of Establishment No. of Employees Products Manufactured No. of Establishment Other Information

10. Location of existing unit :

Unit Name State City Area

Project Status :

11. Location of the Proposed Unit :

Place/Village/Town State District Taluk Industrial Area

Details with respect to above location :

Local Planning Authority Land use classification Nature of land proposed

12. Products proposed to Manufacture / Activity :

Item Activity Item Code Item Description Proposed Annual Capacity Unit Capacity

13. By-Products/Co-Products proposed to manufacture :

Item Code Item Description Proposed Annual Capacity Unit Capacity

14. Raw Material Required :

Item Name Quantity Source

15. Production Details (for five years) :

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Production (projected) Quantity (In Units) Sales values of goods(In Rs.Crores)

16. Environment Clearance from :

17.

Category of Industry (As per KSPCB Guidelines) :

Distance From Water Bodies :

Distance From Nearest Habitation :

Distance From Road(NH / SH / District Road etc) :

Distance From Sensitive Locations:

18. Company Plans for Zero discharge :

19. Investment on Fixed Assets : Rs.(In Crores)

(A) Land

(B) Building

(C) Plant & Machinery

(i) Indigenous

(ii) Imported

(a) CIF Value

(b) Landed Cost

Total A+B+C{i+ii(b)}

20. Cost of the Project : (Rs. in Crores)

(a) Land and Building

(b) Plant and Machinery

(c) Working Capital Margin

(d) Contingency

(e) Others

Total

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21. Means of Finance : (Rs. in Crores)

(a) Promoter's Equity

(b) Institutions Equity

(c) Term Loans

(e) Others

(e) Seed Capital/Risk Capital

(f) Subsidy/Grants

Total

22. ForeignTechnology Agreement is Envisaged:

(i) Name of Foreign Collaborator

(ii) Country of Origin of foreign collaborator

(iii) Terms of Collaboration

(iv) Lumpsum payment(Rs. in Crores)

(v) Royalty:

a) Percent on Domestic sale

b) Percent on Exports

c) Duration of Agreement

23. Equity :

(a) Total Paid-up Capital PREVIEW (b) Foreign Equity

(c) NRI Participation

(d) Repatriable

(e) Non-Repatriable

Furnish the details of Financial Institution

Name of the Bank :

Name of Branch & Address :

Contact details :

Details of the loan sanctioned to the proposed project :

24. External Commercial Borrowing (ECB)

Envisaged / Foreign Direct Investment (FDI) :

Under which route FDI comes as per present

guidelines Percentage of total cost under ECB / FDI

Amount receivable to the project under ECB / FDI (In

Crores) Percentage of production to be exported per annum

Values of production to be exported per annum (Rs. In

Crores) Country to which exports proposed

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PREVIEW

25. Employment : Existing Proposed

(a) Managerial

(b) Supervisory

(c) Skilled

(d) Unskilled

(e) Others

Total

Employable Skills :

26. Expected Date of Commencement of Trial Production :

DATE MONTH YEAR

27. Expected Date of Commencement of Commercial Production :

DATE MONTH YEAR

28. Turnover : (Amount in Crores)

(a) Existing

(b) Proposed

Total

29. Rate Of Tax(%) for proposed turnover : VAT: CST:

Annual generation of tax revenue based on

maximum capacity utilized(Rs. in Crores)

30. Scope for Ancillarization and Down Stream Industries :

Ancillaries Name Productive Values

31. Brief Note on Manufacturing Process, Water Pollution and Air Pollution Details :

32. 1) Land Details(Sq. Meters)

(a) Existing

(b) Required

Total

2) Building :

(i) Existing(Area Sq. Meters)

Building Name Land Required Plinth Area Built-Up Area

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33. Land requested for approval & land utilization details in

Sq.meters : Proposed Area (1 acre = 4047Sq mtrs)

Building Land Details Land Required Plinth Area Built-up Area

FAR=(As per the KIADB Norms)

Total

Plot Coverage=(Plinth Area / Total Area)

34. (a) Mode of acquisition of proposed land :

Land Agency Mode of Acquisition Extent Acres Consent / Agreement from

land owners (In Acres)

(b) If Acquisition is Proposed, Type of Land Identified :

Modeof Acquisition

Type Of

Land

District

Taluk

Village/

Industrial

Area

Owner

Consent

Obtaine

d ?

Survey

No./

Hissa No.

Zone Extents

Acres

Justification of Land : PREVIEW

Total

35. Power : ESCOMs Contract demand (In KVA)

(a) Existing station details in KVA

(b) Already proposed load in KVA

(c) Newly proposed in KVA

Remarks :

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PREVIEW


Connected Load of Plant and Machinery in(HP/KW) 1HP = 0.746 KW)

(a) Existing - Lines

Station ----

(b) Already Proposed - Lines

Station -

(c) Newly Proposed - Lines

Station ---

-

Remarks :

(i) Power Requirement in KVA :

(ii) Time Schedule :

(iii) Type process :

(iv) Mention the Following Parameters Considered for Power Calculation :

(a) Load Factor :

(b) Power Factor :

(v) Do you Have Any Plans for Captive Generation of Power.

(a) Capacity(in KVA) : (a) Source of Fuel :

36. Water Requirement(In Liters Per Day):

Source of water Quantity (In LPD)

37. Present status and assistance required from the Government( 100% EOU letter of

permission,LOI,FIPB approval obtained. Whether IEM filled with Government of India.)

EOU Letter LOI FIPB Approval IEM_GOI Mining Lease

38. Assistance and Incentive & Concessions Sought From Govt. of Karnataka :

Assistance Name Assistance Required

Incentives & Concessions - indicate the policy :

39. Incentive & Concessions Sought over & above policy (applicable for the Mega projects) :

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PROMOTERS BACKGROUND

Details of Promoters/Directors

1.

Name of the Unit

2. Bio-data of promoter/Director

(a) Name

(b) Age

(c) Address

Phone No. Office :

Email :

Res :

Mob :

(d) Academic Qualification

(e) Experience

3. Functional Responsibilities in Unit

4. (a) Personal assets (Rs. In Crores)

(b) Personal Liabilities (Rs. In Crores)

(c) Immovables, Covering details like land and building:

(d) Other assets (Rs. In Crores)

(e) Net worth (Rs. In Crores) PREVIEW

(f) PAN Number

(g) Any other information


Details of Authorized Person

1. Name of Unit

2. Name of the Authorized Person

Designation

Age

Address

Phone No. Office: Phone No. Res :

Email : Mobile No. :

3. Functional Responsibilites of the Authorised Person

application form for approval of projects by st ate … · 2017-07-03 · application form for...

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