(1) The Council or the District Council, as the case may be, shall upload the basic information related to its working including the annual progress report on the official web portal created for the purpose.
(2) The Council or the District Council, as the case may be, shall provide information to the Member Secretary of the National Board for Micro, Small and Medium Enterprises as defined in the Act in the manner and form as required from time to time.
6. In the said rules, for the existing Forms I, II and III, the following forms shall be substituted, namely:- 1874 HARYANA GOVT. GAZ. (EXTRA.), JULY 17, 2023 (ASAR. 26, 1945 SAKA) “FORM-I [see rule 6(1)] To The Chairperson (Name of Concerned) Micro and Small Enterprises Facilitation Council _______________.
Subject: Reference under Section 18 of the Micro, Small and Medium Enterprises Development (MSMED) Act, 2006.
I am authorized representative of M/s -----------------------------. This firm is a micro/ small unit as per provisions of MSMED Act, 2006. This unit had supplied the goods/ services to M/s ---------------------------------, but it has not been paid as per provisions of Section 15 of the Micro, Small and Medium Enterprises Development Act, 2006.
I, therefore, aggrieved with the buyer, wish to file a reference. The information pertaining to case is as under:
1. Udyog Aadhar No./ Udyam Registration No.:
(Proof to be attached) Note- MSE may register Udyog Aadhar on udyogaadhaar.gov.in (https://udyogaadhaar.gov.in) or Udyam Aadhar on (https://udyamregistration.gov.in)
2. Haryana Udhyam Memorandum No.:
(Proof to be attached) Note- MSE may register Haryana Udhyam Memorandum on harudhyam.edisha.gov.in (https://harudhyam.edisha.gov.in/)
3. Date of filing application (DD/MM/YYYY):
4. Details of aggrieved MSE
4.1 Name of Authorized representative:
(authorization to be attached)
4.2 Name of Enterprise (supplier):
4.3 Address (including Pin code):
4.4 District:
4.5 State:
4.6 Mobile No.:
4.7 Email:
4.8 Type of aggrieved Enterprise:
Micro Small
5. Name of respondent (buyer)
5.1 Address (including Pin code):
5.2 District:
5.3 State:
5.4 Mobile No.:
5.5 Email:
5.6 Category of respondent (buyer) [CPSU/State PSU/---------]:
HARYANA GOVT. GAZ. (EXTRA.), JULY 17, 2023 (ASAR. 26, 1945 SAKA) 1875 6 Details of information in respect of claim
(1) Details of purchase orders issued by the purchaser/Respondent with description of material/ Service provided quantity and cost.
Serial No. Purchase Order Number Date of Purchase Order Description
(2) Detailed description of mutually agreed terms and conditions between purchaser and supplier /Agreement / Contract along with stipulated delivery date.
(3) Details of Invoices/Bills raised against purchase order with particulars of material /service name, quantity and cost.
(4) Details of delivery challans /work completion certificates/goods receipt.
(5) Details of material/services acceptance, quantities and date.
(6) Details of paid and unpaid invoices with dates in the order of supplies.
Serial No.
Invoice Number with date Invoice Amount Status (Paid or Unpaid)
(7) Details of completion of forty-five days and appointed day for calculating delayed payment for goods/ services supplied.
(8) Details of correspondence with Respondent for payment of outstanding dues.
(9) Details of complaints/objections of Respondent, if any, against goods supplied/services provided or any understanding between parties and proof thereof.
(10) If a complaint is received from Respondent on supplied goods and services or on mutual agreement, then acceptance of the same by Respondent buyer after rectification/ replacement with date and proof thereof.
7. Principal amount payable:
8. Interest claimed as on:
(Attach calculation sheet as per Form-II)
9. Details of fee paid:
9.1 Amount:
9.2 Mode: Cheque/ Demand Draft/ NEFT (Provide details)
10. Relief Sought
11. Any other relevant information and brief description (Case History)
12. Additional Documents to be submitted:
(a) Photocopy of Udyog Aadhaar Memorandum/ Udyam Registration Number (Prior to the date of 1st invoice);
(b) Photocopy of Haryana Udhyam Memorandum;
(c) Affidavit in support of application.
I hereby declare that information given above is true to the best of my knowledge. Any information that may further be required, shall be provided immediately before the concerned authority.
Signature: _______________________ Name : ________________________ (Authorized signatory on behalf of aggrieved MSE) Date:
1876 HARYANA GOVT. GAZ. (EXTRA.), JULY 17, 2023 (ASAR. 26, 1945 SAKA) INSTRUCTIONS:
1. Claim application is required to be filed on MSME Samadhaan portal of Government of India on https://samadhaan.msme.gov.in ;
2. Printed original copy of the claim application must be submitted to the Council or the District Council, as the case may be, after fifteen days of filing claim on MSME Samadhaan portal. The claim application must be supported by an affidavit in case purchase order is oral;
3. All annexure(s) to the claim application must be self-attested;
4. List of documents duly mentioning the page number in chronological order shall be enclosed along with the claim application;
5. Copies of claim application must be in proportion to the number of the respondents along with one original copy;
6. Incomplete claim application shall not be accepted.
HARYANA GOVT. GAZ. (EXTRA.), JULY 17, 2023 (ASAR. 26, 1945 SAKA) 1877 Form – II [See rule 6(1)] INTEREST CALCULATION Serial No.
Invoice/ Bill Nos.
and Date of Supply order Total amount of Invoice/ Bills indicated in Column
(2) Date of receipt of Goods/ Services by Buyer Amount of Payment received with date against goods supplied/ service provided Delay period Principal amount remaining unpaid Details of bills with bill no. and date on which the interest has been claimed Invoice/ Bill Nos.
Amount
(1) (2) (3) (4) (5) (6) (7) (8) (9) Due date/ 45 days for payment, as the case may be, from the date of purchase order/ agreement or as provided in the Act for calculating the actual date of appointed day Calculation of interest on delayed/ unpaid payment in terms of At/ agreement from the date of appointed day till the date of filing the reference before the Council or the District Council, as the case may be Interest of Bank rate as Notified by the Reserve Bank of India Calculation of Compound interest with monthly interest as three times of the Bank Rate notified by the Reserve Bank of India (as indicated in column (12) from the period from ________ to ________ Remarks
(10) (11) (12) (13) (14) Signature: _______________________ Name : ________________________ (Authorized signatory on behalf of aggrieved MSE) Date:
1878 HARYANA GOVT. GAZ. (EXTRA.), JULY 17, 2023 (ASAR. 26, 1945 SAKA) Form-III [see rule 6(1)] (Undertaking to be submitted by the claimant supplier under MSMED Act, 2006 on the letter head of the enterprise) To The Chairperson (Name of Concerned) Micro and Small Enterprises Facilitation Council _______________.
Subject: Reference under Section 18 of the Micro, Small and Medium Enterprises Development (MSMED) Act, 2006.
I am authorized representative of M/s -----------------------------. This firm is a micro/ small unit as per provisions of MSMED Act, 2006. I hereby confirm that this firm has not moved any reference before the Council or the District Council or any Civil Court on the present dispute.
I, hereby, declare that the information given above is true to the best of my knowledge and belief.
Signature: ____________ Name: _______________ (Authorized signatory on behalf of aggrieved MSE)” The 13th July, 2023 ANAND MOHAN SHARAN, Additional Chief Secretary to Government Haryana, Industries and Commerce Department.
10477—C.S.—H.G.P., Pkl.