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Percival Lamb
5 years ago
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6 psd fylv 1- fu/kkzfjr vkosnu&i= ij vkosnua 2- layxud&,] ch] lh o Mh ij opu&i=] kifk&i=] fcøh dk fooj.k rfkk?kks k.kk&i=a 3- lk>snkjh foys[k rfkk QeZ fucu/ku izek.k&i=] deiuh vf/kfu;e ds vurxzr iathdj.k dh izfr rfkk eseksj.me,.m vkvhzdy vkwq, kksfl, ku dh izfra 4- QeZ ds lk>snkjksa@deiuh cksmz }kjk fn;k x;k izkf/kdkj i= dh izekf.kr izfra 5- y?kq Lrjh; m ksx@[kknh xzkeks ksx cksmz ds vurxzr LFkk;h iathdj.k rfkk bz-,e- Hkkx&2 dh vfhklohd`fr dh izekf.kr izfra 6- Hkkjrh; dkj[kkuk vf/kfu;e] nqdku,oa LFkkiuk vf/kfu;e] vks k/k vf/kfu;e ;k vu; okafnr iath;u dh izekf.kr izfr] ;fn vko ;d gksa 7- okf kzd mriknu {kerk ds ckjs esa pkvzmz bathfu;j dk izek.k&i=a 8- dkj[kkus@m e esa iwath fuos k dk izek.k&i=a 9- xq.korrk izek.khdj.k ds lecu/k esa xq.korrk izek.khdj.k izek.k&i= nsus okyh lalfkk ds izek.k&i= dh izfra 10- v ru vkffkzd fpv~bs dh izfra 11- Hkwfe@Hkou LokfeRo dk izek.k&i=@yht MhMh@jktLo izek.k&i= dh izfra 12- iznw k.k fu;e=.k cksmz dh lgefr i= dh izfra 13- vu; vfhkys[k] ;fn okafnr gksaa

7 m ksx funs kky;] mùkjk[k.m Directorate of Industries, Uttarakhand ivsy uxj] nsgjknwua ¼nwjHkk k% 0135& ] QSDl% ½ lkexzh mikiu ¼Procurement½ uhfr&2014 ds vurxzr lw{e,oa y?kq ¼[kknh] dqvhj] gfkdj?kk,oa glrf kyi lfgr½ m eksa ds iath;u ds fy, vkosnu&izi= 1- vkosnd bdkbz@qez dk uke Name of Applicant firm/unit irk@qksu@qsdl@bz&esy la- Address/Telephone/Fax/ No. of (a eq[; dk;kzy;@head Office (b dkj[kkuk@factory 2-,l-,l-vkbZ-@[kknh xzkeks ksx LFkk;h iathdj.k dh la[;k o rkjh[k] m eh ds Kkiu i= ¼E.M. Part-II½ dh ikorh dh la[;k o rkjh[k 3- vkosnd bdkbz@qez dh izkflfkfr@ Status of applicant firm: (a lalfkkiuk dh rkjh[k@ Date of Incorporation: mriknu@dkjksckj vkjehk djus dh rkjh[k (b Date of commencement of production/business: (c QeZ dh lajpuk@ Constitution of the firm: (i,dy LokfeRo@lk>snkjh@ifCyd fy-@futh lhfer@vks ksfxd lgdkjh ¼la?k ds fu;e o Kkiu rfkk uksvjh }kjk lr;kfir lalfkkiu ds glrk{kfjr izek.k&i= dh izfr yxk,a½ Proprietorship/Partnership/Public Ltd./Pvt. Ltd./Industrial Cooperative (Attach Memorandum & Article of Association and copy of signed Certificate

8 (d of Incorporation duly notarised (ii fgunw vfohkkftr Hindu Undivided Family D;k vkidh QeZ buds varxzr iathd`r Whether your firm is registered under: ¼tks ykxw gks] mls fvd tick as applicable½ (i Hkkjrh; dkj[kkuk vf/kfu;e Indian Factory Act 1948 (ii nqdku,oa LFkkiuk Shops & Establishment Act. vks k/k (iii (iv Drugs Act. vu; visf{kr vf/kfu;e 4- og ftlds fy, iathdj.k dh vko ;drk gs% Stores for which registration is required: (a D;k vki iwfrz,oa fuivku egkfuns kky; ds ikl iathd`r gsaa ;fn gka rks iathdj.k la[;k o rkjh[k crk,aa iathdj.k izek.k&i= dh,d izfr layxu djsa vksj og en fy[ksa] ftlds fy, iathd`r gsaa Whether you are registered with DGS&D? If so, give registration No. and date, attach a copy of registration certificate and specify the item for (b which registered. D;k vkius dksbz Hk.Mkj@mRikn iwfrz o fuivku egkfuns kky; ds ek/;e ls ljdkj dks ;k lh/ks ljdkjh fohkkx dks vfkok fdlh vu; vkiwfrzdrkz ds ek/;e ls liykbz fd;k gs] ;fn gka] rks finys rhu o kz ds vuqcu/k] ;fn dksbz gksa] rks mldk C;kSjk vuqyxud esa nsaa Have you supplied any stores to the Government through DGS&D, Direct to the Government Department or through any other Supplier? If so, give details of the contract if any, during the last three years in Annexure. (c mu Hk.Mkjksa@mRiknksa dk C;kSjk ftuds fy, iathdj.k izkffkzr gsa%

9 Details of the stores/products for which the registration is sought: Sl. No Descriptio n/ Stores/ Products Ref. of BIS Specification/ ISO/ISI etc. Model/ Brand Limiting Size Capacity/ Rating Annual Production Capacity per shift No. of shifts factory normally works Ø- ch-vkbz vkbz-,l,l- fof k V dk ekmy@ lhfer okf kzd mriknu ikfy;ksa dh la- la- mriknksa dk fooj.k lanhkz@vkbz-,l,l-vks vkbz- vkfn czsam vkdkj@ {kerk@ jsfvax {kerk izfr ikyh tks izk;% dkj[kkus esa pyrh gsa dkj[kkus@xksnke ds C;kSjs@ Details of Factory/Godown: (a irk o Qksu la-@ Address & Tel. No. (b D;k fofuekz.k dk;z ikoj ds fcuk ;k ikoj dh lgk;rk ls fd;k tkrk gs] ;fn ikoj dh lgk;rk ls fd;k tkrk gs] rks d`i;k crk,a% Is process of manufacturing is carried out with or without power? If with the aid of power please state: (i gklz ikoj & vkoafvr@ Horse Power allotted (ii gklz ikoj & LFkkfir@ Horse Power installed (c dkj[kkus@doj fd, x, xksnke@fcuk doj dk {ks=]

10 fohkkxksa vksj iz;ksx kkykvksa vkfn dk laf{kir fooj.k% Brief Description of the Factory/Godown Covered/Uncovered Area Departments and laboratories etc. 6- iwath lajpuk dk Detail of capital structure: (a flfkj iwath ¼fcuk ewy;gzkl ds ewy Fixed Capital (original value without depreciation (i Hkwfe vksj Land & Building (ii la;a= vksj e khujh@ Plant & Machinery (b pkyw ifjleifrr ¼blesa dpps eky dk LVkWd] mi;kst; Hk.Mkj] v/kkzfufezr mrikn] fufezr mrikn udn jksdm+] csad vf/k ks k vkfn kkfey gksuk pkfg,½ Current Assets (this should include stock of Raw material. Consumable stores, semi finished/finished products, cash in hand, bank balance etc. Total of (a & (b 7- rduhdh lqfo/kk,a@ Technical facilities: (a layxud&ch ds vuqlkj LFkkfir la;a= o e khujh ds C;kSjs Details of plant and machinery installed as per (b Annexure-B fofuekz.kk/khu Hk.Mkj@mRikn dks fofufnz V djsa Specify stores/products under manufacture (c mriknksa ds rduhdh Kku rfkk izokg pkvz lfgr iwjh lwpuk Full information of the technical know-how of (d products with flow chart. useh rfkk Lohdk;Zrk VSLV ds fy, xq.koùkk O;oLFkk Quality control arrangement for routine and acceptance test. (e VSfLVax e khujh o lqfo/kkvksa ds C;kSjsA

11 Details of testing machinery & facilities. 8- dì;k crk,a fd Vkbi VSLVksa lfgr tgka ;g visf{kr gs] mriknksa dks iwjh rjg ls VSLV fd;k x;k gs ;fn gka rks VSLV fjiksvksza dh,d izfr yxk,aa State if the products have been fully tested, including type tests where required in specifications. If so, attach copy of test reports 9- D;k mriknksa dks fcøh ds ckn lfozl dh vko ;drk gksrh gs mu LFkkuksa dk uke o irs nsa tgka,slh lqfo/kk,a miyc/k gsaa If the products require after sales service, give Names & Addresses of places where such facilities are available. 10- vfrfjdr@osdfyid lwpuk@ Additional/Optional information: (a d`i;k crk,a fd D;k mrikn ch-vkbz-,l-@vkbz-,l-vkbzekdkz gsa ;fn gka] rks os/k ch-vkbz-,l-@vkbz-,l-vkbzykblsal dh,d izfr yxk,aa State if the products are BIS/ISI Marked. If so, (b attach a copy of valid BIS/ISI License. d`i;k crk,a fd D;k QeZ vkbz-,l-vks izek.ku esa gsa State if the firm has ISO 9000 Certification. If yes, attach copy of the same. 11- bl vkosnu ds glrk{kjdrkz dk uke o inuke ¼tgka ykxw gks] eq[rkjukek dh,d izfr yxk,a½ Name and designation of the signatory of the application (enclose a copy of power of Attorney where applicable LFkku@Place: fnukad@date: izkf/kd`r glrk{kjdrkz Authorized Signatory(ies eksgj lfgr@with seal

12 layxud&, opu&i= &i= ¼Undertaking½ I/We ¼;gka vkfn ds uke dk myys[k indicate the name of the Proprietor/Partner/Director/Karta etc.½ ;g?kks k.kk djrk gsa fd bl QkeZ esa Hkjh xbz izkfof V;ka tkudkjh esa lgh gsaa Do hereby declare that the entries made in this application from are true to the best of my/our knowledge. ge tkurs gsa fd vks ksfxd QeZ ds :i esa gels ;g vk kk dh tkrh gs fd fofhkuu Ø; djus okys kkldh; ls lqfo/kk ds lk/kkj.k fu;e o krksza ds vuqcaf/kr jgsaxs] fo ks k :i ls izns k dh vf/kizkfir fu;ekoyh&2008] Ø; ojh;rk uhfr&2014 rfkk m ksx funs kky; }kjk iath;u gsrq fu/kkzfjr krksza dk ikyu djsaxsa bl fuca/ku o krksza ds ikyu djus esa vlqy jgus ij iathdj.k jí gks ldrk gsa We note that an industrial unit/registered firm we are expected to abide by General Terms and Conditions of contracts of various Govt. Departments/Purchasing Agencies/Bodies specially the terms and conditions are contained in Procurements Rules-2008, Purchase Policy-2014 of the state and condition laid down in the registration certificate by Directorate of Industries. Failure on our part to abide by these Terms and Conditions may result in the CANCELLATION of the registration. LFkku@Place: fnukad@date: glrk{kj & Lokeh@Lkka>snkj@funs kd@drkz@eq[rkjukek /kkjh Signature of the Proprietor/Partner/Director/Karta/General Attorney eksgj lfgr@with Stamp

13 kifk&i= kifk&i= ¼Affidavit½ ¼uku tqfmf k;y LVkEi isij ij fu ikfnr fd;k tk, vksj uksvjh vfkok izfke Js.kh eftlvªsv }kjk lr;kfir fd;k tk,½ (To be executed on a Non-Judicial stamp paper of Rupees twenty and to be attested by a Notary Public or 1st class Magistrate esa@ge lqiq= Jh ekfyd@lka>hnkj@funs kd esllz kifk iwozd?kks k.kk djrk gwa@djrs gsa% I/We... S/o... Proprietor/Partner/Director Messrs... resident of... do hereby solemnly affirm and declare as under: fd mi;qzdr QeZ vkerksj ij fueufyf[kr enksa dk fofuekz.k djrh gs% That the above named unit normally manufactures the following items: fd gekjs iw.kz LokfeRo esa vksj esa flfkr esjh@gekjh QSDVªh esa bl le; lalfkkfir lhkh e khuksa dk fooj.k fueufyf[kr gs% That the details of the machines that are exclusively owned by us and presently installed in my/our factory situated... are given below: of Sl. No. Ø-la la- ¼1½ 1- Name of Machine e khu dk uke ¼2½ Date of Purchase Original Value of Machines of accessories [kjhn dh rkjh[k mikaxh lfgr e khu dk ewy ewy; ¼3½ ¼4½

14 fd mi;qzdr la;a= o e khujh ds dqy dks /;ku esa j[krs gq, ge y?kq m ksx bdkbz ds fy, fu/kkzfjr dh xbz lhek ds Hkhrj gh gsaa ;g fd dkj[kkuk ifjlj ds Hkhrj j[ks gq, LVkWd dk vuu; LokfeRo esllz dk gs vksj mlh ds }kjk iz;ksx fd;k tkrk gs rfkk LVkWd dk C;kSjk bl izdkj gsa That in view of the total value of plant & machinery as detailed above, we are well within the ceiling limit prescribed for a Small Scale Unit. That the stocks held in the factory premises are exclusively owned and used prescribed for a Small Scale Unit. That the stocks held in the factory premises are exclusively owned and used by Messrs... and details of the stocks are as under: fd iathdj.k ls igys ;k ckn esa dksbz,slh QeZ tks izfrcaf/kr@fuyafcr gks xbz gs vksj ;g Lokeh@lka>hnkj@funs kd bl gsfl;r esa gs] rks lwpuk izkir gksus ds 15 fnu ds Hkhrj jk Vªh; y?kq m ksx fuxe dh iathdj.k kk[kk dks lwfpr djsaxsa That to inform the Registration Branch of NSIC immediately after we are informed but in any case not later than 15 days, if any firm in which proprietor/partner/director are proprietor/partners/directors of such a firm which is Banned/Suspended in future either before the registration is granted or thereafter. kifkdrkz@deponent esa@ge] mi;qzdr kifkdrkz ;g lr;kfir djrk gwa@djrs gsa fd mdr kifki= dh fo k; olrq esjh@gekjh tkudkjh vksj fo okl ds vuqlkj lgh gs vksj mlesa dqn Hkh fnik;k ugha x;k gsa I/We the above named deponent(s do hereby verify and affirm that the contents of the above affidavit are true and correct to the best of my/our knowledge and belief and that nothing has been concealed there form. kifkdrkz@deponent

15 finys rhu o kksza ds nksjku QeZ ds izpkyu o forrh; flfkfr ds ifj.kke n kkzus okyk,d fooj.k uhps fn;s x;s QkeZ esa fn;k tkrk gsa A statement showing the Results of Operation and Financial Position of firm during preceding three years in the format given below: 1- fcøh ¼ldy½ Sales (Gross mrikn kqyd (- (Less Excise Duty fcøh dj (- (Less Sales Tax VªsfMax lsy (- (Less Trading Sales usv lsy Net Sales dj ls igys kq ykhk Net Profit before tax finyk o kz nwljk o kz Last Year Last but One Year rhljk o kz Last but Two years ¼izkf/kd`r glrk{kjdrkz½ (Authorized Signatory ¼lunh ys[kkdkj ds glrk{kj] eksgj lfgr½ (Chartered Accountant Signatures with Seal bdkbz@daiuh dh eksgj Stamp of Unit/Company

16 lw{e,oa y?kq ¼[kknh] dqvhj] gfkdj?kk,oa glrf kyi lfgr½ m eksa }kjk glrk{kj fd;k tkus okyk?kks k.kk&i= Declaration to be signed by the Micro & Small Enterprises esaus@geus] vkosnu i= esa nh xbz iathdj.k dh krsza i<+ yh gsaa esa@ge mls iwjh rjg ls le>rs gsa vksj ;g iqf V djrk gwaadjrs gsa fd mldk iwjh rjg ls ikyu djus ds fy, lger gsaa I/We have gone through the conditions of the registration detailed in Annexure-E of the Application. I/We fully understand the same and confirm that I/We agree to fully comply with the same. esa@ge iwjh rjg ls ;g le>rs gsa fd i;kzoj.kh; Dyh;jsal lfgr lhkh fo eku dkuwuksa@vf/kfu;eksa@lkafof/kdksa tks fuekz.k dh gekjh ykbu ij ykxw gsa rfkk vk;dj@vkbz- Mh-vkj- vf/kfu;e ds rgr ykblsal o iathdj.k@dhvuk kd ykblsal@uxj fuxe ykblsal@vks k/k ykblsal@ck;yj ykblsal] ch-vkbz-,l- ykblsal@dkj[kkuk vf/kfu;e iathdj.k vksj vu; ykxw dksbz vf/kfu;e@dkuwu@lkafof/kd vko ;d vis{kkvksa ds lhkh izkfo/kkuksa dks ikyu djus dk nkf;ro esjk@gekjk gs geus bu@vu; lhkh lkafof/kd vis{kkvksa dks ikyu djrs gq,] m ksx funs kky; ds ikl iathdj.k ds fy,,d vkosnu&i= izlrqr fd;k gs vksj mlds lq/kkj o iwjk djus dh fteesnkjh gekjs Åijh gksxha I/We fully understand that it is incumbent on my/our part to comply with the provisions of the all existing laws/acts/statues as applicable to our line of manufacture and other provisions like Income-Tax/licensing and registration under IDR Act/Insecticide License/Municipal Corporation License/Drug License/Boiler License/BIS License/Factory Act Registration and any other applicable Acts/Law/statutory requirements including the requirements of environmental clearance etc. We have submitted an application for registration with Directorate of Industries after having complied with these/all other statutory requirements and onus for corrections and fulfillment of the same would be on us. LFkku@Place: fnukad@date: izkf/kd`r glrk{kjdrkz Authorized Signatory(ies eksgj lfgr@with seal

v/;k; & 6 ukxiwj ftyk eap esa fookn fuivkjk,oa xzkgdksa dh tkx:drk dk lfe{kkred fo ys k.k

v/;k; & 6 ukxiwj ftyk eap esa fookn fuivkjk,oa xzkgdksa dh tkx:drk dk lfe{kkred fo ys k.k la kks/ku esa izkir fd, x;s,ao ladfyr fd, x, vkdmks lkghr;hdh; fo ys ku fd;k x;k gsa,ao mlds vuqlkj lkj.kh o xzkq