Application_formApplication ID:(For office use)APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTERS EMPLOYMENT GENERATION PROGRAMME (PMEGP)Preference for sponsoring agency of the project to Bank:(mark )KVICKVIBDICRURALURBANTO.District Industries CenterState:1Name of the Applicant/Institution7/2/742Date of Birth:DDMMYYYYAge ( in Years)27197439Male23SexMaleFemaleFemale4Father's/Spouse's/Contact person Name (if Institution):Khadi & V.I. CommissionKVIC45Communication Address:Khadi & V.I.BoardKVIBDistrict Industries CenterDIC (Rural)District Industries CenterDIC (Urban)Taluk/Block:District:PinRural2Email:Contact No:Urban6Address of the Proposed location of Unit:RuralUrbanNo1YesTaluk/Block:District:Pin:SC87Name of the preferred Bank Name & Address in the Area for Project Sanction:STOBCPHCTaluk/Block:Ex- ServicemanDistrict:Branch Code:MinorityHill Boarder Area8QualificationGeneralAcademicTechnicalUnder 8thManufacturing29Whether Entrepreneur Development programme (EDP at least 2 weeks) under gone: (mark )YesNoServiceName & Address of Training InstitutePeriod of TrainingCertificate Issue Date2FromToUnder 8th8th Pass10th Pass12th Pass10Whether the applicant belongs to (mark )GraduateSCSTOBCPHCEx- Service manMinorityHill Boarder AreaGeneralPost GraduatePhDOwn211Whether the project (mark )Manu-facturing UnitService UnitRented12Name of the project / business activity proposed :Leased13Amount of loan required (in Rs.)Building TypeCapital Expenditure LoanWorkshedBuilding etc.Machinery/ Equipment/FurniturePre OperativeCostWorking Capital / Cash Credit LimitTotalRented0000014Details of earlier or current Loan/Grant and subsidy availed from Central/State Govt. Scheme/ or any other Similar Scheme.Activity of the Project with AddressAmountYear of SanctionI certify that all information furnished by me is true; and that I and any of my dependent have not borrowed any money under subsidy linked scheme from any Central / State Government or bank for establishing any such projectPlace:Date:Signature of the ApplicantFor Official Use only:(Rejected / to be placed before District Task force Committee)Reason (if Rejected):Place:Signature, Name & Designation of OfficerDate:NOTE Own contribution must be invested 5% for SC/ST/OBC/PHC/woman/ Ex-serviceman/ North East Reason/Hill Boarder Area and 10% for General Total Project Cost should not exceed 25 lakhs for Manufacturing unit and 10 lakhs for service unit. Applicant will not be entitled for additional Margin Money(Subsidy) in case of Own Contribution over and above the prescribed limit. VIIIth pass for Manufacturing Unit above Rs.10 lakhs project cost and under Service Sector above Rs.5 lakhs Application should be submitted complete in all respect along with attested copies of the following documents:1. Certificate of qualification-academic and technical (if project cost above 5 lakhs under service industry or above 10 lakhs under Manufacturing industry)2. Relevant Certificate for SC/ST/OBC/Minority/Ex-Servicemen/PHC3. if Entrepreneur Development programme(EDP) training undergone (at least for two weeks) then submit photocopy of the certificate

PHOTOSelect Academic Qualification from the listSelect sponsoring agency from the listSelect Gender from the listSelect EDP Training taken from the list if EDP Training Taken enter Name of the institution, training period and certificate issue date etc.Select Social category of Applicant from the listSelect Unit type from the list

Data SheetDATA INPUT SHEETLegal Status:LandBUILDING DETAILSParticularsAreaRate/Sq.ftAmount in Rs.0.000.000.0010.000.000.000.000.00MACHINERY DETAILSParticularsQty.RateAmount in Rs.0.000.000.000.000.000.000.000.000.000.000.000.00Total0.00d. Preliminary & Pre-operative Cost :e. Furniture & Fixtures :f. Contingency/Others/Miscellaneous :0.00Working Capital :0.00Means of FinancingOwn Contribution :5%Bank Finance :95%Margin Money (Govt. Subsidy) :25%DETAILS OF SALESParticulars of ProductsRate/QantityAmount in Rs.UnitStone carving products0.00Stone Artware & Decorative Prod.0.000.000.000.000.000.00Total0.00RAW MATERIALSParticularsUnitRate/UnitReqd. UnitAmount In Rs.0.000.000.000.000.000.000.000.000.00Total0.00WAGESParticularsNo. ofWages Per MonthAmount in Rs.WorkerTotal Month120.000.000.000.000.000.000.00Total00.00SALARY DETAILSParticularsNo. ofWages Per MonthAmount in Rs.StaffTotal Month120.000.000.000.000.00Total00.00WORKING CAPITAL ESTIMATEElement of Working CapitalNo. of DaysRaw materialsStock in processFinished goodsReceivable byPOWER ESTIMATEPower RequirementRepair and MaintananceRs.0.00Power and FuelRs.0.00Other Overhead ExpensesRs.0.00Telephone ExpensesRs.0.00Stationery & PostageRs.0.00Advertisement & PublicityRs.0.00Building RentRs.1000.00Other Miscelleneous ExpenditureRs.0.00Rate of InterestDepreciationOn Building5.00%On Machinery10.00%Pay back period5Project Implementation Period212INTRODUCTIONABOUT THE PROMOTEROffice Address:.District Industries Center000State:0Name & Signature Inchargewith round seal

Enter Total Area inSq.ft / Sq.mtEnter actual Rent per MonthEnter No. of QuarterEnter present rate of InterestEnter Estimated power requirement in HP/KW/W

DPR_printDISTRICT INDUSTRIES CENTERPROJECT AT A GLANCE - TOP SHEET1Name of the Entreprenuer02Constitution (legal Status) :Individual3Father's/Spouce's Name04Unit Address :00Taluk/Block:0District :0Pin:0State:0Phone :0E-Mail :05Product and By Product06Cost of Project:Rs.07Means of FinanceTerm LoanRs.0.0KVIC Margin MoneyRs.0.00Own CapitalRs.0.008Debt Service Coverage Ratio:0.009Pay Back Period:5Years10Project Implementation Period:12Months11Break Even Point:0.00%12Employment:013Power Requirement:014Major Raw materials:,,15Estimated Annual Sales Turnover:Rs.0.00DETAILED PROJECT REPORT1INTRODUCTION :02ABOUT THE PROMOTER :03COST OF PROJECTA. Fixed Capital Investmenta. Land :0Ownb. WorkshedArea Sq.ftRate in Rs.Amt. In Rs.000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00Total0.000C. MachineryQty.RateAmount in Rs.000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00Total0.00d. Preliminary & Pre-operative Cost :Rs.0.00e. Furniture & Fixtures :Rs.0.00f. Contingency/Others/Miscellaneous :Rs.0.00Total Capital Expenditure :Rs.0.00Working Capital :Rs.0.00Total Cost Project :Rs.0.003.1Means of Financing :Own Contribution5%Rs.0.00Bank Finance :95%Term LoanRs.0.00Working CapitalRs.0.00TotalRs.0.00Margin Money (Govt. Subsidy) From KVIC25%Rs.0.00Margin Money Subsidy received From KVIC will be kept in term deposit as per norms ofPMEGP in the name of Beneficiary for three years in the financing branch.3.2STATEMENT SHOWING THE REPAYMENT OF TERM LOAN & WORKING CAPITAL :TERM LOANYearOpening BalanceInstallmentClosing BalanceInterest @0.00%1st00002nd00003rd00004th00005th00006th00007th00008th0000WORKING CAPITALYearOpening BalanceInstallmentClosing BalanceInterest @0.00%1st00002nd00003rd00004th00005th00006th00007th00008th00003.3STATEMENT SHOWING THE DEPRECIATION ON FIXED ASSETS:WORKSHED@5.00%Particulars1st Year2nd Year3rd Year4th Year5th YearOpening Balance00000Depreciation00000Closing Balance00000MACHINERY@10.00%Opening Balance00000Depreciation00000Closing Balance00000TOTAL DEPRECIATIONWorkshed00000Machinery00000Total000004Schedule of Sales Realization :4.1Details of SalesParticulars of ProductRate/No. ofAmount in Rs.Pair/UnitPair/Unit0Stone carving products0.0000.00Stone Artware & Decorative Prod.0.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.00Total0.004.2Capacity Utilization of SalesParticulars1st Year2nd Year3rd Year4th Year5th YearCapacity Utilization70%80%90%90%90%Sales / Receipts000005Rawmaterials :ParticularsUnitRate/unitReqd.UnitAmount in Rs.000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00Total0.005.1Wages :ParticularsNo. ofWagesAmount in Rs.WorkerPer Month(Per Annum)000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00Total00.005.2Repairs and Maintenance :Rs.0.005.3Power and Fuel :Rs.0.005.4Other Overhead Expenses :Rs.0.006Administrative Expenses :6.1Salary000.000.00000.000.00000.000.0000.000.0000.000.00Total00.006.2Telephone Expenses0.006.4Stationery & Postage0.006.5Advertisement & Publicity0.006.6Workshed Rent12000.006.7Other Miscellaneous Expenses0.00Total12000.007Capacity Utilization of Manufacturing & Administrative Expenses :Particulars1st Year2nd Year3rd Year4th Year5th YearCapacity Utilization70%80%90%90%90%Manufacturing ExpensesRawmaterials00000Wages00000Repairs & Maintenance00000Power & Fuel00000Other Overhead Expenses00000Administrative ExpensesSalary00000Postage Telephone Expenses00000Stationery & Postage00000Advertisement & Publicity00000Workshed Rent1200012000120001200012000Other Miscellaneous Expenses00000Total:12000120001200012000120008Assessment of Working Capital :ParticularsAmount in Rs.Sale0.00Manufacturing ExpensesRaw Material0.00Wages0.00Repair & Maintenance0.00Power & Fuel0.00Other Overhead Expenses0.00Production Cost0.00Administrative Cost12000.00Manufacturing Cost12000.00Working Capital Estimate :Element of Working CapitalNo of DaysBasisAmount in Rs.Raw materials0Material Cost0.00Stock in process0Production Cost0.00Finished goods0Manufacturing Cost0.00Receivable by0Manufacturing Cost0.00Total Working Capital RequirementPer Cycle0.009Financial Analysis9.1Projected Profit & Loss Account :Particulars0 Year1st Year2nd Year3rd Year4th YearSales / Receipts00000000Manufacturing ExpensesRawmaterials0000Wages0000Repairs & Maintenance0000Power & Fuel0000Other Overhead Expenses0000Depreciation0000Production Cost0000Administrative ExpensesSalary0000Postage Telephone Expenses0000Stationery & Postage0000Advertisement & Publicity0000Workshed Rent12000120001200012000Other Miscellaneous Expenses0000Administrative Cost12000120001200012000Interest on Bank credit @ 0%Term Loan0000Working Capital Loan0000Cost of Sale12000120001200012000Net Profit Before Tax-12000-12000-12000-12000Less Tax0.000.000.000.00Net Profit-12000-12000-12000-120009.2CALCULATION OF DEBT SERVICE CREDIT RATIO (D.S.C.R) :Particulars0 Year1st Year2nd Year3rd Year4th YearNet Profit-12000-12000-12000-12000Add :Depreciation0000TOTAL - A-12000-12000-12000-12000Payments :On Term Loan :Interest0000Installment0000On Working CapitalInterest0000TOTAL - B0000D.S.C.R = A/B0.000.000.000.00Average D.S.C.R9.3PROJECTED BALANCE SHEET :Particulars0 Year1st Year2nd Year3rd Year4th YearLIABILITIES :Promoters Capital0000Profit-12000-12000-12000-12000Term Loan0000Working Capital Loan0000Current Liabilities0000Sundry Creditors0000-12000-12000-12000-12000ASSETS :Gross Fixed Assets :0000Less : Depreciation0000Net Fixed Assets0000Preliminary & Pre-Op. Expenses0000Current Assets0000Cash in Bank/Hand-12000-12000-12000-12000Total-12000-12000-12000-120009.4CASH FLOW STATEMENT :Particulars0 Year1st Year2nd Year3rd Year4th YearNet Profit-12000-12000-12000-12000Add : Depreciation0000Term Loan0000Working Capital Loan0000Promoters Capital0000Total-12000-12000-12000-12000Total Fixed Capital Invested0Repayment of Term Loan0000Repayment of WC Loan0000Current Assets0000Total0000Opening Balance0-12000-24000-36000Surplus-12000-12000-12000-12000Closing Balance-12000-24000-36000-480009.5BREAK EVEN POINT AND RATIO ANALYSIS :Particulars0 Year1st Year2nd Year3rd Year4th YearFixed Cost12000120001200012000Variable Cost0000Total Cost12000120001200012000Sales0000Contribution (Sales-VC)0000B.E.P in %0.00%0.00%0.00%0.00%Break Even Sales in Rs.0000Break Even Units0000Current Ratio0.000.000.000.00Net Profit Ratio0.00%0.00%0.00%0.00%This Project Report has been prepared based on the data furnished by the entrepreneur whose details are given in the application.Place :0Date:31-Dec-99Prepared by :.District Industries Center000State0Full Name :0e-Mail:0Ph. No.:0Signature of the BeneficiaryFax:0Name & Signature Office Inchargewith round seal

&L&G&L&"Tahoma,Regular"&8PMEGP Project Report&RPage &P

Project_ReportPROJECT REPORT FOR0Affix latestattestedPhotograph1Name of the Entreprenuer01Individual2Constitution (legal Status) :IndividualCo-Operative SocietyRegd. InstitutionS H G's3Father's/Spouce's Name0Trust5Unit Address :00Taluk/Block:0District :0Pin:0State:0Phone :0E-Mail :06Background of the Proprietor/Partners/Directors :Furnished detailed information in the DPR7Name of Business House/Group if any :8Details Other Companies/Units in the group :Other Companies / Units in the Group(Rs. in Lakhs)Name & AddressBusinessEquityReservesLoansTurnover*P.B.T**P.A.Tof Company / Unit* Profit Before Tax** Profit After Tax`8.1How the activity was financed so far :( To be filled up in case of existining unit Only )*Source of FundsSecurityRate ofRepayment perPresent O/sAmount of DefaultInterestMonth( Rs. in '000 )(if any)8.2If the Unit is an ancillary one, undertaking towhich it is catering and its address :8.3Employment :PresentProposed000000000000000000000000Total09Project Details for Proposed New Unit :Copy of detailed project report is enclosed.aExpansion / Mordenisation :bSetting up of New unit :cActivity for proposed new unit :dProduct / Item proposed to undertake :9.1Capacity (Furnish the details of Installed capacity & production :(No. in Units/ Qty. in Kg./Volume in liter per annum)Capacity is arrived at on the basis ofDays working onshift basisProduct &Present InstalledMaximum Prod.Proposed InstalledMaximum Prod.By-product if anyCapacityAchievedCapacity of 1st Yearenvisaged70.00%09.3State the manufacturing process in brief :9.4Has the proposed process ever been tried in thecountry or newly adopted? :9.5Technical Arrangements :9.6Describe arrangement for Key Officialfor managing the proposed unit :Technical ManpowerAdministrative ManpowerAccounting personnel9.7Particulars of LandExistingProposedLocation of the Land :Area of Land :Status of the Land :Nature of Land :Availability of Water :9.8Particulars of BuildingExistingProposed(Enclose the plan & Estimation for the proposed Building)AreaValue in Rs.StatusAreaValueStatusFactory Building :Ancillary Building :Storage :Total :0.000.009.9Plant and MachineryExisting (Value in Rs.)Proposed (Value in Rs.)Indigenous0.00Imported(Enclose the plan layout of the existing plant and machinery )9.10Rawmaterials / ComponentsReq. of Raw material/Components/ChemicalsQty. in Nos./Kgs./TonRate/Nos./Kgs/TonsValue in Rs.Total0.009.11Utilities (Furnish details on requirement, availability, adequacy, qualitative aspects etc..)Particulars of UtilitiesContracted LoadConnected LoadFurther requirementin HP/KW/Win HP/KW/Win HP/KW/WPowerWaterFuelOthers (Specify)9.12Environment Aspect of the Project :9.13Requirement of Manpower for the Project :Particulars of ManpowerTotal RequirementSalary/Wages per monthCost per Annum000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00Total00.009.14Schedule of Implementation :B A R C H A R TActivitiesDate of CommencementExpected Date of Completiona. Acquisition of Landb. Development of Landc. Civil Works for Factory / BuildingMachinery / Foundation etc..d. Plant & MachineryImportedIndigenouse. Arrangement for powerf. Arrangement for waterg. Errection of equipmenth. CommissioningI. Procurement of Raw materials/Chemicalsj. Trail Runsk. Commercial Production10Cost of Project :(Rs. in '000)Sr.No.ParticularsAlready IncurredTo be IncurredTotal CostALand including Development0.000.00BBuilding & Other Civil Works0.000.00CPlant and Machinery1. Indigenous0.000.002. Imported0.00DFurniture & Fixture0.000.00ETesting equipment0.00FMiscellaneous Fixed Assets0.00GErrection & Installation Charges0.00HContingency0.000.00IPreliminary & Pre-Op. Cost0.000.00JProvision for1. Buildings0.002. Plant & Machinery0.003. Other Fixed Assets0.00KWorking Capital for one0.000.00Operating CycleLTotal0.000.000.0011Means of Financing :(Rs. in '000)Sr.No.ParticularsAmount alreadyAmount ProposedTotalRaisedto be RaisedAEquity / Promoters Contribution0.000.00BReserves0.00CTerm Loans0.000.00DUnsecured Loans and Deposits0.00(Indicate sources, roi, repayment etc)EDeferred Payment0.00Arrangements including Suppliers creditFSubsidyCentral Government0.000.00State Government0.00GSeed Capital0.00HInternal Cash Accruals0.00IOther Sources (Specify)0.00JTotal0.000.000.0011.1In case internal accruals are taken assource of finance explain the basis ofestimation of internal accruals :11.2Indicate source from which expenditurealready incurred has been financed :11.3% of Promoters contribution of the :total cost of project12Marketing & Selling Arrangements of the Product :13Projected Profitability :Projected Profitability Statement given in theDetailed Project Report.14Projected Cash flow Statement :Projected Cash flow Statement given in theDetailed Project Report.% of Cash Sales in Total Sales :Period in which payment is receivedDaysin respect of Credit SalesAverage Credit Available on Purchase :Days15Working Capital Required for the :Rs.0.00anticipated turnover16Repayment Programme :Detailed Repayment programme for Term loan andWorking capital loan have been given in the DPR.17Details of Securities to be Offered :17.1Primary ( Furnish details for term loan and : :working capital loan separately )17.2Collateral, if any (Details) :17.3Details of Guarantor(s) :1. Name :2. Residential Address :3. Occupation :4. Details of movable & immovableproperties owned by him /her/otherfamily members5 Details of any other similar guarantees:if any, given to other institutions18Government Consents :(Give deatails of various licenses / consents required to be obtained from various authorities for the proposed project)19DECLARATIONI / We hereby declare that the information given herein before and the statements and other papers enclosed are, to the best of our knowledge and belief, true and correct in all particularsDate :0Signature of the BorrowerPlace :0Name & Designation (In case of Regd. Inst.)

Enter name of product hereIf the Proprietor / Institution runs any other existing activity which may be clearly indicated here.If any Company & Unit exists in the name of Individual / Inst. the details as per table may be furnishedEnter type of work undertakingEnter Name and Detailed Address of the undertaking to which the unit working as ancillary.Enter the present strength of manpower in the existing firm other than REGPEnter any one of the following appropriate for the proposed activity.ManufacturingProcessingServicingEnter no. of working days of the unit per annumEnter no. of shift per daySingleTwoThreeEnter name of main Product and by-product if any seperatelyEnter installed capacity of existing unit. Otherwise enter NA.Enter the value of maximum production achieved under existing unit, otherwise enter NAEnter the value of proposed production under new unit as per project reportEnter installed capacity of proposed new unit as estimated in the project reportBrief here the process of manufacturing of the proposed product. If more space required insert more rows and merge with the existing one.Indicate briefly onSpecific processing technique of the product.Suitability/adoptability of the process at the location.Indicate briefly onSatisfactory arrangement for Know-howCollaboration involvement if any and financial participation.Details of consultants if any.Give brief on the source, experience, cost to meetout the proposed tech. Manpower.Give brief on the source, experience, cost to meetout the proposed Admn. Manpower.Give brief on the source, experience, cost to meet out the proposed Accounting personnel.Indicate the Village/Town/ Dist./State where the land is located.Indicate the total area of the land in Sq.mt / Sq.ft.Enter hereLeased orOwnedEnter hereAgriculturalNon-AgriculturalIndicate here, availability and suitability of water for the proposed project.Indicate the Village/Town/ Dist./State of the proposed land if it is not with the existing one.Indicate the total area of the proposed land in Sq.mt / Sq.ft.Enter hereLeased orOwnedEnter hereAgriculturalNon-AgriculturalIndicate here, availability and suitability of water for the proposed project.Indicate the status of buildingLeasedOwnedIndicate the status of buildingLeasedOwnedIndicate the status of buildingLeasedOwnedIndicate the status of buildingLeasedOwnedIndicate the status of buildingLeasedOwnedIndicate the status of buildingLeasedOwnedList the required Raw materials / Components/Chemicals required for the projectsEnter the Quantity in terms of Nos./Kgs/TonsEnter the rate per unitEnter Total ValueEnter total requirement of power in HP/KW/WEnter connected power if any in HP/KW/WEnter further power connection if any in HP/KW/WBrief here nature of atmospheric, soil and water pollution likely to be created by the proposed project and measures proposed to control the same. Indicate the clearance of pollution control board.Enter the Nature of ManpowerEnter 'Yes' or 'No'WarningDo not enter any data here!Enter Name of Guarantor hereEnter hereFull address of the guaranterEnter hereOccupationList hereDetails of Movable / Immovable property owned by him/her/themEnter hereThe property details and bankEnter Brief notes on1. The Products and Uses2. Scope for market & Special features if any3. Competition 4. Potential for export5. Sales arrangement made

DPR_FRONTProject Report on0Prepared By:.District Industries Center000State:0e-Mail:Ph. No.:Fax:

&L&G