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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/
KARNATAKA UDYOG MITRA
1. User Id
Name Of the Company / Unit
Country of Origin if MNC
Correspondence Address Pin Code Telephone No. Fax No.
Mobile
Corporate / Office Address
Pin Code
Telephone No.
Fax No.
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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KARNATAKA UDYOG MITRA
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) :
Page 4 of 11
KARNATAKA UDYOG MITRA
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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KARNATAKA UDYOG MITRA
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 : PREVIEW
(a) Total Paid-up Capital
(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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KARNATAKA UDYOG MITRA
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
PREVIEW
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
Page 7 of 11
KARNATAKA UDYOG MITRA 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
Total
FAR=(As per the KIADB Norms)
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 :
Mode of Type Of Village/
Consent Survey
District Taluk Industrial Owner Zone Extents
Acquisition Land Obtaine No. /
Area
Acres
d ? Hissa No.
Total
Justification of Land : PREVIEW 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 : Page 8 of 11
KARNATAKA UDYOG MITRA
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):PREVIEW
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) :
Page 9 of 11
KARNATAKA UDYOG MITRA
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 : Res :
Email : 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 Page 10 of 11
KARNATAKA UDYOG MITRA
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
Page 11 of 11
