--:: SURAT SPECIAL ECONOMIC ZONE ::--

Application Form

APPLICATION FOR SETTING UP UNIT IN SURAT SPECIAL ECONOMIC ZONE

Note:

Please see Paras 4.1 to 4.3 of EOU Scheme and Paras 7.2 to 7.4 of SEZ Scheme.
Please read the general instructions given in EOU/SEZ Scheme before filling
this application and also some important guidelines given at the end
of this application.
The application may be sent electronically or otherwise. But the same will be
treated as incomplete without its own permanent E-mail and will not be considered.

INDICATE WHETHER FOR
AUTOMATIC APPROVAL OR BOARD OF APPROVAL

The application should be submitted to the Development Commissioner of the concerned Special Economic Zone (for setting up EOUs) units in SEZ/in 3 copies along with a crossed Demand Draft of Rs.5,000/- drawn in favour of the Pay & Accounts Officer,Ministry of Commerce & Industry, Department of Commerce, payable at the Central Bank of India, Udyog Bhavan,New Delhi. No fee shall be charged for renewal/extension of LOP/Broad banding etc.)

For official use only
Application No	Date:
Date Month Year

Details of Bank Draft
Amount Rs. Draft No.

Draft date. Drawn on.
(Name of the Bank)

Payable at

NAME AND ADDRESS OF THE UNDERTAKING IN FULL(Block Letters) Name of the Applicant Firm Full address	Regd.office in case of limited companies & Head Officer for others)
Pin Code	Tel.No.
Fax no	Web site,if
Permanent E-mail address	Passport no.if any
Name of Bank with Address & A/c.No.
Digital signature	Income Tax PAN No.

NATURE OF THE APPLICANT FIRM: [Please write( Y/N) the appropriate entry]	Government
Undertaking / Public-Limited Company / Private-Limited Company / Proprietorship / Partnership / Others (please specify)

Note:- Copy of certificate of incorporation along with Article of Association and Memorandum in case of companies and partnership deed in case of partnership firms may please be attached.

INDICATE WHETHER THIS PROPOSAL IS FOR
[please write(Y/N) the appropriate entry] Establishment of a New Undertaking	Manufacturing
	Services
Effecting substantial expansion Manufacturing of new product Conversion of

(i) existing DTA unit into EOU/SEZ
(ii) existing STP/EHTP to EOU/SEZ
(in case of conversion, please attach fact sheet as per Annexure)

(1)	LOCATION OF THE PROPOSED UNDERTAKING
	Full address SURAT special Economic Zone, Near Sachin Rly Stn. Pin code Sachin 394230
(2)	ONLY FOR PROJECTS UNDER EOU SCHEME
	(In case the unit is proposed to be located on leased premises, then lease should be obtained form Govt.or any undertaking/authority of Govt.However, in case lease is obtained from private parties, it shall have a validity period of five years from the date of LUT and the Development Commissioner shall satisfy himself of genuine nature of the lease.)
(a)	Please indicate if the proposed location is in a Centrally Notified Backward Area [please write(Y/N) the appropriate entry]
	If yes, indicate category
(b)	(b) Indicate whether it is within 25 kms.from the periphery of the standard Urban area limit of city having population above one million according to 1991 census.

(c)	Is it located in an Industrial Area/Estate designated/set up prior to issuance of Notification No.477(E) dated 25th July,1991.

(d)	If not, does it come under the category of non-polluting industries as notified by the Govt.

ITEM(S) OF MANUFACTURE/SERVICE (Including by-product/Co-products) (If necessary, additional sheets may be attached)

Item(s) Description	Capacity (Unit=)	Item Code (ITC HS Code No.)

PRODUCTION (In case of more than one item, supplementary sheets may be used)

	Quantity (Unit	Value (In Rupees)
	(Not required for service unit)
1st year
2nd year
3rd year
4th year
5th year

INDIGENOUS REQUIRMEENT:	(Value in Rupees)
(a) Capital Goods
(b) Raw material, components, consumables, Packing material, fuel etc.during the Period of 5 years
Total:

FOB VALUE OF EXPORTS

	Rupees (lakhs)	US $ (Thousand)
1st year
2nd year
3rd year
4th year
5th year

INVESTMENT

(Rs.in lakhs)
(a)Land
(b)Building
(c)Plant & Machinery

US $ Thousand
(i)Indigenous
(ii) Import CIF value
Total (i) + (iii)

WHTEHR FOREIGN TECHNOLOGY AGREEMENT IS ENVISAGED
[please write(Y/N) the appropriate entry]

Yes	No

(i) Name and Address of foreign collaborator
(ii) Terms of collaboration
(a) Lumpsum payment
(Rupees lakhs)
(Gross of Taxes)
(b) Design & drawing fee
(c) Payment to foreign technician
(d) Royalty (on exports)
(e) Royalty (On DTA sales if envisaged)
(f) Duration of agreement	no.of years

EQUITY INCLUDING FOREIGN INVESTMENT

(i)	($ thousand)	(Rs.lakhs)
(a) Authorised
(b) Subscribed
(c) Paid-up capital

Note: If it is an existing company, please give the break up of the existing and proposed
Capital structure
(ii) Pattern of share holding in the paid-up capital (Amount in Rupees)

	(Rs.in lakhs)	(US $ Thousand)
(a) Foreign holding
(b) Non-Resident Indian company/ individual holding
(i) Repatriable
(ii) Non-repatriable
(c) Resident holding
(d ) Total [a+b(I+ii) equity
(e) (iii) External commercial borrowing

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