application format for design projects (simplified version)
TRANSCRIPT
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