(1) Every Authority shall furnish to the Government on or before 30th September every year returns, statements and particulars in Form-D.
(2) The Authority shall submit a report containing matters as laid down in sub-section (2) of Section 23 of the Act in Form-E to the Government on or before 30th September every year.
RAJEEV RANJAN, Principal Secretary to Government.
TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY APPENDIX FORM A [See rule 4 (1)] Single Application Form Part — I TheAuthority, Special Economic Zone Address:
1. Name of the Developer or entrepreneur
2. Address
3. Nature of manufacture or service activity
4. Particulars of letter of Approval given by the ..
Central Government.
5. Fees:
i) Amount ii) Bank Draft or cheque No. with Date iii) Drawn on ( ( (
(iv) Payable at
6. Nature of the Organization :
|:| Proprietary |:| Partnership |:| Private Limited |:| Public Limited |:| Co-operative |:| Others Project Status: D New Project |:| Expansion |:| Diversification Name and Address of Project Promoters Name and Address of the Local Contact Person 6 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY Line of manufacture :
Sl.No. Item of Description Item Code Installed Capacity Unit Capacity (lTC/NIC) Names of the Byproducts :
8/. No. Item of Description Item Code Output based on Unit of Output (lTC/NIC) Annual Capacity of Main Product ROC Registration No.
Estimated Project Cost (Rs. in Lakhs) :
Land I I Building I I Plant and Imported (Landed Cost) I I Machinery Indigenous I I Misc. Assets I I Contingencies, etc., I I Others (IDC) | | TOTAL I I Means of Finance (Rs. in Lakhs) :
Equity from Promoters |:| Domestic |:| Foreign Loans from Financial Institutions TIDCO’s equity if any Others (PI. Specify) TOTAL TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 7 Registration (please fill the one applicable) FIPB / RBI Approval No. Date IEM No. Date EOU Regn. No. Date LOl No. Date Amount of Foreign Investment : (in rupees) Foreign Equity (%) Expected date of commencement of construction :
Expected date of commencement of commercial production :
l / we hereby declare that the above statements and the particulars given in the applications in Part II are true and correct to the * * best of my/our knowledge and belief. I / We fully understand that any license, permission or registration or approval under one or more State * * Acts granted to me/us on the basis of above statements and particulars given in the application in Part II is liable for cancellation or any other legal action may be taken, if it is found that statements or particulars are incorrect or false. An undertaking in support of the above information is enclosed.
Place: Signature of the Applicant Date: Name in Block Letters Designation :
Tel. No. :
Email Full Residential Address:
Official Seal / Stamp:
* Strike out whichever inapplicable.
8 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY
PART II In this Part, the Developer or entrepreneur shall append the applications that are required to be submitted for grant of licence, permission or registration or approval under one or more State Acts along with the fees payable for such application under the relevant State Acts, complete in all respects, for forwarding by the Authority to the authorities concerned who are competent to grant the license, permission or registration or approval under the relevant State Acts.
UNDERTAKING (by Developer) l/We, Mr/Ms (name of the authorized signatory) Designation of (name of the Industry and address of registered office) hereby declare that the information furnished by me/us to the Authority , Government of Tamil Nadu by me/our company in this application are true to the best of my/our knowledge and belief. l/We indemnify the Authority or any agency under Government of Tamil Nadu from any liabilities whatsoever that may arise due to inaccuracies, errors etc. in this application and my/our company management assumes complete responsibility in this regard.
Further l/We undertake to provide any additional information or clarification as required by Government of Tamil Nadu agencies while processing my/our application. l/We undertake to pay the fees or charges payable to Government of Tamil Nadu agencies as prescribed under rules for according approvals or clearances.
l/We understand that this facility is to assist my/our company in getting statutory clearances (listed in this application) expeditiously. l/We indemnify authority from any liabilities whatsoever.
Place: Signature:
Date: Office Seal of the Company:
FORM B [See rule 4(2)] Single Return or information Part — I To The Authority, .............................. Special Economic Zone, Address:
(1) Name of the Developer or entrepreneur
(2) Address
(3) Nature of manufacture or service activity
(4) Particulars of letter of Approval given by the Central Government.
Part II The Developer or entrepreneur shall enclose in this Part the returns or information that are required to be submitted under one or more State Acts.
TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY Expenditure To Establishment expenses Salaries including allowances.
Administrative and other expenses Rent, rates and fixes Insurance Telephone, Postage, Telegram and Telex charges Legal charges Electricity charges Audit fees Consultancy charges Technical fees Other professional charges Conveyance and travel Bank interest Depreciation on Assets Other expenses Excess of expenditure over income Liabilities Capital Opening balance Add grants and loans received Add Sums received Add excess of income over expenditure Less excess of expenditure over income Closing balance Other current liabilities FORM C (See rule 14) Annual Statement of Accounts Income and Expenditure Account (in Rs.) Income (in Rs.)
By grants received By loans received By sums received for user or Service charges By fees received By sums received from other sources By Bank interest Excess of income over expenditure.
Balance Sheet Amount Assets Amount (Rs) (Rs.)
Land Buildings Furniture Vehicles Other fixed Assets Fixed Deposit in Bank Other Current Assets Cash in Bank Cash in hand 1O TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM D [See rule 16 (1)] Returns, Statements and Particulars Number of Units in existence— Number of applications in Form A received— Number of applications in Form A forwarded to the authorities— Number of applications in Form A returned to the applicants— Number of applications in Form B received— Number of applications in Form B forwarded to the authorities— Number of applications in Form B returned to the applicants — Details regarding development of infrastructure — Details of export promotion activity.— Number and nature of studies conducted for development of Special Economic Zone, Conferences and Seminars.— Number of meetings held during the year.
Publications, books, etc., published during the year.
Date: Signature of Chief Executive of the Authority Seal of the Authority: Authority of ...............
Special Economic Zone.
FORM E [See rule 16 (2)] Report to Government Particulars as contained in Form D.
(i) The activities of the Authority are as follows:— (Give a true and full report of the activities hereunder)
(ii) The policy and programmes during financial year are as follows:— (Give a true and full report of the policy and programmes hereunder) Date: Signature of Chief Executive of the Authority Seal of the Authority: Authority of ...............
Special Economic Zone.
PRINTED AND PUBLISHED BY THE DIRECTOR OF STATIONERY AND PRINTING, CHENNAI ON BEHALF OF THE GOVERNMENT OF TAMIL NADU