APPLICATION FORMAT FOR DESIGN PROJECTS (Simplified version)

Note: Fill only the clear blocks. The shaded blocks are not applicable to the proposer from that cotegory

# DETAILS

1 Proposer

2 Designation

3-a Name of the Unit

4 Address

4 Udyog Aadhar Number (UAN)

5

Mobile

Contact Details

5-a Name of the official

5-b Designation

5-c

5-d EmaillD

6 Year of establishment

Products being currently 7 manufactured

8 Profit & Turn over. During the last three financial years

MSME

-----1

Student

9

f--o---- -I_

Any patents held by the company, including pa ents filed.

FY-l (in Rsi-)

I Turnover: Profit :

FY-2 (in Rs/-)

I Turnover . I Profit

I FY-l (in Rs/ )

Turnover: Pro It

r--- ,- tt f--

1 ame of t

- - - 2 Category

(ex. Mech/e 0- ---

Descriptio

Please not

3 - CI in es

- M to

- Existing I product(

Please nat a

4 - H in

- a

- P

----

5 Potential develop

Duration

Please not 6 -

- E d! (

-

DETAILS

he Concep

tec/oqn etc.)

n of the Concept.

e early bring out the novation/navelty/uniquen s in the proposal oy also include references any research papers, etc.

- evel of technology / s) in the market

e ring OUI gop-analysis ow this gop is eliminated your proposed Ideo.

May odd your research data nd analysis

Must not infringe on any otent/IPR of anybody.

for patenting once ed, please explain.

of the project

e Must not exceed 10 months xtension only Dt the 'scretion of the Head I MSME-CoE) _

PART -B (Proposal details)

---------, Brief data

PART -C (Financial details)

DETAILS Brief data

#

Name Contact details

------ -- Proposed Design Consultant (if any)

1

Tentative Budget (in Rs/-)

2 Please refer to the allowable & non­ allowable expenditures, as set out in the approved guidelines of the Scheme.

I

I -------

Any other information which you 3 would Ii e to add to support your

proposal

---- - - or applrcoble In case of students' proposals

Bought Out Items ~ Raw Materials

I Processing &/or Labour t - -------- Design Consultan (charges)

~- Others (specify)

TOTAL (of above)

Signature with date (Along with nome, designation & official seal)

I daclaro 1.!12t:

/Cons.ntant, fer __ Dc sig 1 f rrn ----

2. 1 he cornpar- I has not applied, 0[;\<: '-1 "'1 or "NiI' b .... cb:amini3 (il'Y other taxjfinanciJi incentives or the p oposecJ cons" z r cv project.

3. The cornpanv is frc_ from on'lli"Ligation to the proposed p(cject.

4. The facts stated in this z.ppli ation and [' e :1ccoinpanying informutiOIl are true and correct to the

best 0 my k odeclgc c::nd that i have 'lot w;;llheid/distortcd 'j, y m;;tr~(k" facts: and s. Th(~ cornpanv fell" undo- the de' nition of 1'.1(' ;~ cJS (Sir ke at!' whld- '5 appl':"able)

b. ~:,.", .:;:'" ani is pmfitable for last three vears and has nul been granted 011/ flniinCial support from

7. ',\[:;} e !illing to pav rnctc ing fund JS per sch.:::me 'J·del'nc.

8. h case the projecris approved. I un. crtake to mz.ke fac litics : 'ailahle 0 carrv tout, tc arrane0 for

the submtssio 0 periodic prog rss reports 3'1d other irfryrn;.,tioli t ar may e req~;, ec hi' DC l;:y rvlSf lIEs.

9. I certify that I shal: en, :re tna- 2::COU;1tS ofth - funds recc'v0!l and scent will b kept and made available on demand, as specified and rcquirad by DCS for I\lS \Ls_

10. I take responsi ilil\, to comple:e pro ect at" jJ2' the proposed ::.ctl'/.;::; and de \erc,' 'es '.:i,i the

mentioned rojc: t dura ian. - C3<;e of failure 0 pr ject d'Je 10 I?ck of mar ;f2ctunni5!::om . 2r-JLiI

capabllitv, ir. any stage of project, I " refuno the gr lit rccciv (' back to [\liD.

-----_ -. --- SIG ATURE OF ~OLE

p, OPRIETOR./PAR '~;ER/CO .~D.!I.' Iy

DIRECTOR/[\ OjCEO

'---- ---- JMI'1E