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Application Format for Claiming Reimbursement of CertificationCharges of acquiring ISO-9000 Certificate under the Incentive Schemeof O/o Development Commissioner (SSI), M/o Small Scale Industries,Nirman Bhawan, New Delhi-110001.

1. (a) Name and address of the unit

b) Telephone No. Factory & Office

(c) E-mail & Fax

2. Details of PMT SSI Registration No.; date ofissue; Directorate of Industries/ GM, DICof the State Concerned

3. Item(s) of manufacture/processing asindicated in the PMT SSI Registration

4. Proof of SSI status and functional status ofthe unit as on date of submission ofApplication. The following document(s) to besubmitted

i)A certificate (in original) from State DI/GM,DIC confirming SSI and functional status

of the unit at the time of acquiring ISO-9000/ ISO-14001 certificate; as on date asper Format at Annexure I

OR

ii)An Affidavit (in original) from ManagingDirector/Director/Proprietor/Partner of theSSI unit duly sworn before a Notary Publicconfirming the SSI status and functionalstatus of the unit at the time of acquiring

ISO-9000/ ISO-14001 certificate; as ondate, (As per Format Annexure II)accompanied by CA certificate of the totalinvestment in plant & machinery as ondate (original purchase value) (As perFormat Annexure III)

5. Details of ISO-9000/ISO-14001 CertificateName & address of Certification agency; TheCertificate must have address of thesite/location certified; Scope of certification,Certificate No, date of issue & period of validity(or date of expiry), Name & Logo & Number ofthe Accreditation Body/Board.


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6. Details of expenditure incurred in acquiringISO-9000/ISO-14001 Certificate (excludinghotel & travel expenses & surveillancecharges). Furnish a CA certificate ofexpenditure (in original) giving the details

(as per the Format Annexure IV)

7. Details of reimbursement/grant/subsidyalready received, if any, from Central Govt(including DC(SSI) /State Govt./FinancialInstitution etc. ) for acquiring ISO-9000/ISO-14001 Certificate. Furnish, an Undertaking/declaration (in original) from the Managing

Director/Director/ Proprietor/ Partnerof the

SSI/ancillary units duly sworn before Notary

Public as per the Format Annexure V)

8. Pre-receipt to be furnished as per Format atAnnexure VI.

Declaration:

I, Mr. Pradeep Kabra s/o of Shri ?????????, Director of M/s KabraIndustries.,address???????????????? hereby declare that the particulars given in the

application are correct. In case any of the statement/information furnished in theapplication/documents later found to be wrong or incorrect or misleading, I do hereby bindmyself and my unit to pay to the Government on demand the full amount received asreimbursement in respect of above mentioned activity, within seven days of the demandbeing made to me in writing.

For????????????????

Director(????????????)


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ON Rs.20/- STAMP PAPER duly attested by NOTARY BY AFFIXING Rs.25/-NOTARIAL STAMP ON IT

AFFIDAVIT

I, Pradeep Kabra s/o ??????????, Director, M/s Kabra Industries with their Regd. Officelocated at ????????? & Factory located at???????? with permanent SSI

Registration No. ?? dt. ??? do hereby solemnly affirm and declare that under:

1. The Company has been a SSI/ancillary/Tiny/SSSBE unit as per Govt. of Indiadefinition; and has been functional & in production at the time of acquiring ISO-9000certification No. ????????????? dated ????????????.

2. The Company/Firm/Establishment continues to be a SSI/ancillary/Tiny/SSSBE unit;and functional & in production as on date.

3. As per books of account, the total investment (original purchase value) in plant &machinery in the Company as on 31.03.2005 is Rs. ??????? /-(Rs. ???????????????????only) (Chartered Accountant Certificate dated????????? to this effect is attached).

Signed on this day ofJune, 2005 dt.

DEPONENT

VERIFICATION:

I do solemnly affirm that the contents of the Affidavit are true to the best of my knowledge& belief.

DEPONENT

Date:

Place:


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ON Rs.20/- STAMP PAPER duly attested by NOTARY BY AFFIXING Rs.50/-NOTARIAL STAMP ON IT

(DO NOT DELETE THE WORDS ISO-14001)

UNDERTAKING/DECLARATION

I, Pradeep Kabra s/o Shri ???????, Director, M/s Kabra Industries with Regd. officelocated at ?????????? & factory located at ??????? and with Permanent SSIRegistration No. ?? dt. ??? do hereby solemnly affirm and declare that under:

(a) That the aforesaid Company have not availed reimbursement/subsidy/grant/incentive for acquiring, ISO-9000/ISO-14001 Certification under any Schemeoperated by Central Govt. (including o/o DC(SSI), M/o SSI)/ State Govt. / FinancialInstitution etc.

(b) That the aforesaid Company have not applied to any Central Govt./ StateGovt./Financial Institution (except O/o DC (SSI), Ministry of SSI), forreimbursement/subsidy/ grant/incentive, for acquiring ISO-9000/ISO-14001 Certification.

(c) That after availing reimbursement for ISO-9000/ISO-14001 Certification from Officeof DC(SSI), Ministry of SSI, in respect of the said Company, I shall disclose this fact onbehalf of the said Company/Firm/Establishment(s) at the time of claiming/ receivingreimbursement/subsidy/grant/incentive, if any, under any other similar scheme run byCentral / State Govt. / Financial Institution etc.

(d) I hereby solemnly affirm that the information given above is correct. In case abovedeclaration is found wrong or incorrect or misleading, I do hereby bind myself & my unitand undertake to pay to the Government on demand the full amount received asreimbursement in respect of above mentioned activity, within seven days of the demandbeing made to me in writing.

Partner/proprietor/Director

In the presence of :-

Name signature and address of 2 witnesses.

1. (Write name, ADDRESS and have SIGNATURE of concerned person)


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(On CA letter head) 2 copies

TO WHOM IT MAY CONCERN

Verified from the Books of Accounts of M/s Kabra Industries with their Regd. Officelocated at ????????? and Factory located at ??????? with permanent SSIRegistration No. ?????????? dt.?????????, that the total investment in plant &

machinery (original purchase value) of the Company as on date 31st

March, 2010 standsat Rs. ?????????/- (Rs. ???????????????????only).

ForChartered Accountants

Place:Dated:

(Name of Partner)Membership No.


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(On CA letter head) 2 copies

To Whom It May Concern

The documents and records of M/s Kabra Industries with their Regd. office located at

??????? and factory located at ?????????, Permanent SSI RegistrationNo. ?????????? dated ???????, in respect of the expenditure incurred by them in

acquiring ISO-9000 Certificate (or its equivalent) have been verified; and it is certified that

the said Company has incurred a total expenditure of Rs. ?? /- (Rupees ????

Thousand ???Hundred ????only) towards; Application fee; Assessment/Audit fee;

Annual fee/License fee; Training; Calibration; and Technical Consultancy etc. (excluding

hotel & travel expenses & Surveillance charges) in obtaining ISO-9000/ISO-14001 from

the Certification Agency namely ?????????????????????????; as per the following

details of payments:

Details of Payments Amount in Rupees

a) Application Fee paid to ????????

b) Assessment/Audit Fee paid to ????????

c) Annual Fee/License Fee paid to

d) Calibration charges paid to ????????

e) Technical Consultancy charges paid to ?????

f) Training expenses paid to ???????

TOTAL 0

ForChartered Accountants

Place:Dated:

(Name of Partner)Membership No.


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ON YOUR LETTER HEAD(3COPIES)

(DO NOT FILL THE AMOUNT)

PRE-RECEIPT

Received a sum of Rs. _____________________________(Rupees -_______________________

__________________________________________ only) from the Development

Commissioner (Small Scale Industries) towards the reimbursement of expenses incurred

for obtaining International Quality Certification ISO-9000/ISO-14001

AFFIX RE.1/- REVENUE STAMP, THEN PUT RUBBER STAMP OF DIRECTOR, THENSIGN ON IT (ON ALL THE THREE COPIES) SIGNATURES SHOULD BE ON THESTAMP


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(on letter head)To,

The Industrial Adviser,Office of the Development Commissioner (SSI),Ministry of Small Scale Industries,7th Floor, A Wing, Nirman Bhavan,New Delhi-110001

Sub: Application for reimbursement of ISO-9001 Certification Charges

Dear Sir,

We are a small scale unit registered with DIC, Vasai, Thane District. We have undergonean ISO certification from URS Certifications Ltd. and have incurred Rs. 55,000/- asexpenses .Now we are enclosing following documents for claiming ISO subsidy from youresteemed office.

1. Application.2. Copy of Permanent SSI Registration Number duly attested by Chartered

Accountant.3. An Affidavit duly sworn before a Notary Public.4. Chartered Accountants Certificate of investment in Plant and Machinery.5. Copy of ISO-9001 Certificate duly attested by Chartered Accountant.6. Chartered Accountants certificate of the details of the Expenses incurred by the

unit in acquiring ISO-9001 Certificate.7. Undertaking of the Incentive/grant/subsidy already received, if any, on a Non-

Judicial Stamp paper, with witnesses name & their addresses & signatures, NotarySeal, Notarial Stamp & Notary Registration Nos.

8. Pre-receipt in triplicate.9. Copy of receipt and bill of Certification body duly attested by C.A.

You are requested to reimburse our certification charges at the earliest and oblige.

Thanking you,

Yours faithfully,

For ???????

Director


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