msme nasik form

PART - II
PriceRs.40/- *
243
MEMORANDUMFOR
ENTREPRENEURS
SETTINGUP MICRO,SMALLORMEDruM ENTERPRISE
GeneralInstructions
asthecasemay
istobefiledwittrttreDistictIndustiesCente*byaMcro, SmallorMediumEnterprises,
1. Memorandum
(MSMED)
Development
Act,2006.
(l) of Section
8 of ttreMcro, SmallandMediumEnterprises
be,underSubsection
shouldbefiled.
2. FourcopiesoftheMemorandum
ttreMemorandun.
3. Thereisnofeeforprocessing
4. Existingunitushouldfill uponlypart II ofttreMemorandum.
to Distict
informthedetailswittrinthreemontlrs
in *re informatiorlat anypointof timg please
5. In caseof anychange
IndrsfiesCente.
inblock(capital)letters.
6. WriterType
7. Leaveoneblankboxaftereachword.
is applicable.
8. Fill upwhichever
than
9. AII codesother PIN Codeshallbefilledby theoffice.
byttreDistict IndustiesCente.
numbered
10.Formwill bemachine
to besubmittd
Documents
l.
2.
3.
4.
5.
(EM)Part-Icompletely
filled.
Memorandum
forEntepreneurs'
Application
(ELP)Part'II
to LocalPersons
FormatforEmployment
IndstialEstate
fromMIDC authorities/Co-operative
sublettingpermission
offerletter/plot
receipt/plot
Plotpossession
in casetheplotis obtained
bytansfer.
IndustialEstate
letterfromMIDC autlroritieVCo-operative
Plottmnsfer
local
bodies/munici.
certificate
fiom
objection
location
clearances/No
obtain
is
to
Theapplicantunit supposed
of enterprise
to
Also,it is theresponsibility
pal counciUmunicipal
corporationto set-upand run theenterprise.
from
State
Government/Cenhal
run
the
enterprise
to
setup
and
necessary
obtainall permissionflicences/registations
authorities.
Govemment/ottrer
Codesfor Unit of Quantity
STANDSFOR
ABBREVIATIONS
Metue
MI
KIVI
SQM
tt
CIJM
T
KG
NO
1}INO
PR
TTIPR
GROSS
Kilomehe
Sq.Meue
Lifre
CubicMete
Tonno
Kilogram
Number
Number
Thousand
Pairs
Pain
Thousand
Gross
ABBREVIATIONS
TTIGR
RM
TTIBO
LAKHNO
DOZ
GRMS
TTIMT
KWH
MCC
CR
NS
STANDSFOR
ThouandGoss
Ream
Thousand
Boxes
LakhNumber
Dozen
Gram
Thousand
Mete
KilowattHour
Mllion CubicCentimete
Carat
Not Specified
II
Schedule
Procedurcoffiling ofEntrcpreneursMemorandumandothermatters,incidentalthereto
fromtlre
of whichcanbeobtained
fiomtheinteme!theaddress
canbedownloaded
Memorandum
l. FormoftlreEntepreneurs
or ttrehard
or theUnionTenitories
of theStateGovemment
dealingwittrMicrq SmallandMediumEnterprises
Direptorate
fromtlreSmall
Centes.Thisformcanalsobedownloaded
copiesof thesamecanbe obtainedfromtheDistict Indusnies
or www.smallindustryindia.com
. IndusfiiesDevelopment
websitei.e. www.laghu-udyog.com
Organisation
in providing
engaged
or a mediumenterprise
athisdiscretion;
a miuo or smallenterprise,
to establish
2. Anypnon whointends
of goodsshall
or production
in themanufacture
engaged
or a mediumenterpdse
may,at hisdiscretion
of servic,es
or rendering
Cente
of its areawith DistrictIndusfiies
of ltrficro,Smallor asttrecasemaybe,of MediumEnterprise
file theMemorandum
afterallotting
andissueanacknowledgement
in theformof theMemorandum
Centre
shallfill all thecodes
3. TheDisfiictIndustries
of theunitwithinfive daysof thereceiptof theformof
number,
dateof issueandcategory
Memorandum
anEntrepreneurs
aswellasonline.
in person
is submitted
day,if theformof Memorandum
Memorandum
by post0r same
and
in all respect
shallmakesurethattheformis complete
Centres
theDistrictIndustries
4, Beforeissuing
theacknowledgement,
Memorandum.
whichis a partof theformof Entrepreneurs
withanundertaking,
particularly
andis accompanied
theformis signed
of micro,smalland
sofiledin respect
Memorandum
recordof all theEnhepren€urs
shallmaintain
Centre
5. TheDi$rictIndustries
a copyoftheEntrepreneun
shallforward
Industries
Centres
services.
District
in providing
andrendering
medium
enterprises
engaged
of theirStateor
Service
Institutes
allotted
to theSmallIndushies
number
Memorandum
Memorandum
sofiledwithEntepreneurs
theirJurisdiction.
of medium
enterprises
sofiledin respect
Memorandum
of all theEntrepreneurs
Cenhe
shallmainhinrecord
6. TheDi$rictIndustries
with
Enhepreneur
Memorandum
onecopyeachof theEntrepreneurs
of products
andforward
engaged
in producion
ormanufacturing
or
Jurisdiction
andto lointDevelopment
State
their
Institutes
of
their
Service
to SmallIndustries
number
allotted
Memorandum
(SmallScale
Indu$ries).
Commissioner
intheOfficeof theDevelopment
(Micro,SmallandMedium
Policy)
Enterprise
Commissioner
in
engaged
enterprise
a micro,smallor medium
whointends
to establish
is in two puts.Anyperson
7. Theformof Memorandum
intheproduction
ormanufacture
engaged
medium
enterprise
providing
mayfile orthosewhowantto establish
of services
orrendering
Centre.
to DistrictIndushies
Memorandum
of produch
shallfile PartI of theEntrepreneurs
services,
theyshallfile PartII of theEntrepreneurs
or rendering
or startproviding
startproduction
8. 0ncetheaboveenterprises
Centre.
Memorandum
to DistrictIndustries
(PartD
withintwoyearsof thefilingof PartI, theMemorandum
Memorandum
of PartII of theEntrepreneurs
9. In caseof non-filing
will become
invalid.
filedbytheentrepreneur
filedEntrepreneurs
whohavealready
theenterprises
or in equipment,
in plantandmachinery
in theinvestment
10.In caseof change
change
in invesfinent.
writing
within
three
months
of
the
in
of thesame
Centre
informtheDishictIndustries
Memorandum
should
whichhavealready
filed
theenterprises
or services,
or addition
in products
of products
andthatof services
ll. In caseof change
of thechange.
in writingwithinthreemonths
of thesame
Cenfie
shallinformtheDistrictIndustries
Enbepreneun
Memorandum
oncomputer.
records
electronically
in writing,shallalsomaintain
a record,
of keeping
shall,in addition
Centre
12.TheDishictIndushies
for morethan6
in casetheunitis foundclosed
shallbeliableto becancelled
Memorandum
Entrepreneurs'
13. TheAcknowledged
atserialnumber
filedor didnotfollowtheinstructions
Memorandum
in theEntrepreneurs'
or fumished
wronginformation
months
under
anofficialnotbelowtheauthority
byanenquiry
in writingfollowed
based
onanycomplaint
to beinitiated
l0 of thisSchedule
(3)
8 of thesaidAct.
of subsectionsand(4)of section
under
theprovisions
Memorandum
theEntrepreneurs'
notified
for accepting
changes
frommicroto
the$atusof theenterprise
in case,
PartII again,
Memorandum
hasto file theEntrepreneurs'
14 Theenterprise
In
in plantandmachinery/equipments.
in theinvestment
or vicevers4asa resultof enhancement/decrease
smallor smallto medium
with
the
of
the
along
copy
andtheletterof cancellation
issued
earlierneedto becancelled
suchcases'
theacknowledgement
periodof
that
if
for
it
may
take
benefrt,
any,
so
that
(certified)
provided
to
the
industrialist
be
acknowtedgement should
cancelled
functioning.
( bothmanufacturing
and
filedby theMicroandSmallenterprises
Memorandum
of theEntrepreneurs,
15 Outof thethreecopies
with Entrepreneurs,
Memorandum
totheEnterprise
second
retumed
Centre,
bytheDistrictIndustries
service),
firstshould
beretained
Institute
concerned.
Enterprises
Development
to Micro,SmallandMedium
beforuarded
No.allotted,
andthirdshould
(bothmanufacturing
first
andservice),
enterprises
filedbythemedium
Memorandum
of theEntrepreneurs'
16.Outof thefourcopies
Memorandum
No.
withEntrepreneurs'
returned
to theEnterprises
second
Centre,
shouldberetained
bytheDistrictIndustries
concerned
andfourthcopyshouldbe
Institute
Development
Enterprises
to Mlcro,SmallandMedium
threeforwarded
allotted,
(Micro,Smalland
Commissioner
of theDevelopment
PolicyDivision
Enterprises
to theMicro,SmallandMedium
forwarded
NewDelhi.
Enterprises),
7thFloor,A Wing,NirmanBhavan,
Medium
of name
thechange
(l of 1956)
firmsandtrusts,
cooperative/partnership
Act,1956,
in Companies
asdefined
17.In caseof companies
for
filing
or
notified
or theauthority
Centre
DistrictIndustries
Manager,
to General
if any,should
beinformed
of theenterprise,
firms,thesameshouldbe
In caseof ownership
of change.
withinthreemonths
in theStateAJT
Memorandum
Entrepreneurs'
in namealongwithanaffidavit.
of effecingthechange
withinthreemonths
communicated
bespecific.
ofProduct
should
18.Deatils
Form No.
PART II
(To be filled up andsubmittedto the Dishict IndustriesCentreafter commencement
of productivity/activity)
I\IEEDTO BEFILLED ONLYTO TIIE EXTEM TIIAI THE
GHE ROWSWHICII HAVEBEENREPREATED
VARYFROMTHOSEIN PARTT)
ACTUALDETAILSON COMMENCEMENT
(PartI)
Number
Memorandum
L Entrepreneurs
W
l-o l-tfol
tI
D D M MY
Y
tr. Dateof Issue
M M
Itr. Month of Commencementof Production/activitv
l. Name ofApplicant
2. a) Addressof Communication
PIN
i) TelephoneNumber
ii) Fax Number
iii) Cell PhoneNumber
iv) E-mail
V) Web-site
b) PermanentResidentialAddress (Main Applicant)
PIN
i) TelephoneNumber
ii) FaxNumber
iii) Cell PhoneNumber
Y
b
iv) E-mail
V) Web-site
3. Name of Enterprise
4. Locationof Enterprises
i) Village/ Town
Village/Town Code
ii) Tehsil/Taluka/I4andal
Tehsil/Taluka/MandalCode
iii) District
N A S H
K
District Code
iv) State
M A H A R A S H T R A
StateCode
v) PIN Code
vi) Area(Rural-1,Urban-2)
5. Categoryof Enterprise
(Micro-1, Small-2,Medium-3)
6. Natureof Activity [Tick AppropriateBox(es)]
i) Manufacture
ii) Service
T
r
T
T
l
7. Nahueof Operation
Casual-3)
l, Seasonal-2,
@erennial8. Whethertheunit is an ancillary
(Ycs-1,
No-2)
T
M
M
9. Monthof Installationof PlantandMachinery
10. Whetherthe Unit is registeredunderFactoryAct
(UnderSection
2m(i/2m(ii)'1,85(iy85(ii!2,notregistercd-3)
11.Typeof Organisation
Co-operative'4,
Parfirership'3,
Family-2,
(Proprietoryl, HinduUndivided
Others-8.)
Group-7,
Self-Help
PublicLimitedCompany-6,
LimitedCompany-5,
Private
12.
Y
Y
Y Y
I
l
Activity
a) Main Manufachring/Service
Name
Code(NIC 98*)
to be provided
b) Productsto be Manufactured/Service
i) Name
Code(ASICC2000*)
ii) Name
Code(ASICC2000'I)
iii) Name
Code(ASICC2000*)
iv) Name
Code(ASICC2000*)
v) Name
Code(ASICC2000{')
as per classificationspecifiedfrom time to time by office of
(*) Codesfor activitiesand productVservices
(SmallScaleIndusnies),to be filled in by the Distict IndustiesCente or the
Commissioner
theDevelopment
officewheretheEntepreneurs'Memorandumis submitted'
(Add Additionalsheetfor nore pnoducts)
13.
(A) Investnentin fixed assets[Rupeesin tak]tl
i) Land(Owned4l rRented-02/Leased-03)
Value*
ii) Building (Owned-0I /Rented-02/Leased-03)
Value*
iii) Plantand Machinery
Value*
Qncaseof mantrfacturingenterprise)
Value*
iv) Equipment
(ln caseof serviceenterPrise)
v) ForeignEquitY,if anY
Value*
10laktrsit shouldbewrittenas
rightside,e.g.if thevalueisRupees
[*Thevaluein theboxesshouldbefilledin fiomthe
etc.,to begivenl
number,
alsoapplytoallotheritems(rowOwherequantity,
ffirf.Thiswill
14. InstalledCaPacitYPeranilrm'
Qty.
(iii) PlantA
Product
Product
Product
Product
'
(iv)
PlantB
Qty.
Product
Product
Product
Product
15.
PowerLoadH.P./K.W.
16.
(a) i) Othersourceof Energy/Power
TTTT
[If required]
PetoleumGas-4'
iNo po*"t needed'I, Coal'2,Oil-3,Liquid
Non ConventionalEnergy-7'
it..iririty from Grid-S,Elecfricityfrom Generator-6,
TraditionalEnergYffirewood-8)
ii) If no powerrequired,speciff reasons;
(b) Indicateannualrequirement
Unit
Sourceof EnergY
17.
EmploYment
i) Managementand Office Staff
ii) SuPervisory
iii) Workers
Qty.
(in Rs.)
Tumover
18. TotalAnnual
(If lessthanoneyearof operation,
thenexpected
tumover)
19. Export(in any)(in Rs.)
(of all Parfrrers/Directors
of theorganisation.
Useseparate
sheets,
if needed)
20. Entrepreneurs'Profile
a) Name
f
f
i) Male(M) /Female(F)
(5)
Challenged
ii) SC(l) / ST/ (2)OBC(3)/ Others(4)Physically
Level
iii) Knowledge
1,Management
Graduate-2,
PostGraduate-3,
Graduate[Technical
AnyotherLower-6]
Under-Graduate-5,
otherGraduate-4,
(in Rupees)
iv) Equityparticipation
(In Percentage
of totalequity)
(Yes-l,No-2)
Enterprises
v) Stakein otherManufacturing
(AddAdditionalSheet,
If needed)
T
rtr
r
D D M M Y Y Y Y
of Production/Activitv
2I. Dateof Commencement
Date:
Place:
of theApplicant/Authorised
PenonJ
[Signature
Director]
lNarneof theProprietorlPartner/lvlanagement
Resolutior/Society
Resolutioqwhercver
applicable,
while
copyof Powerof AttomeylBoard
a) Enclose
a self-certified
Person.
DirectororAuthorised
siglingasPartrrer/Itdanaging
Deed/Memorandum
ofAssociatior/Articles
ofAssociation
in case
copyof ttreParfirership
b) Enclose
a certified/notariznd
ofMediumEnterprises.
Undertaking
in FormNo. .............
in thememorandum
........is Fueand
furnished
Thisis to certifythattheinformation
approval/ consent
/ License/ permitfrom
andbelief.I / Wehaveobtained
conectto thebestof my knowledge
/ IIf Administration
asstatutory
/ StateGovemment
of Cental Government
Ministry/ Department
theconcerned
requirements.
Date:
Place:
of theApplicant/AuthorisedPenon]
[Signature
FormNo.
DISTRICT INDUSTRIESCENTRE,NASHIK
ACKNOWLEDGEMENT (PART-II)
1.
:
hasfiled memorandumfor a
(Manufacturing/service)
Enterpriseattheaddress
forthe item/items
PIN
indicatedbelow & activity has corlmenced from the date
2:
Sr.
No.
asstatedin FormNo.
MemorandumNo. asbelow :'
& allocatedEntrepreneurs'
to beprovided
Detdilsof item/itemsto be manufactured/service
Items of manufacture/tYPe of
Service to be rendered
Capacify in case
of manufacture
Initial date of
production/
commencement
of service
I
2.
3.
+.
5.
(Add additionalsheetif required)
Detailsof Plant& Machineryasper date-wiseinvestment
Investmentin Plant & MachinerylEquipments
Sr. No.
I
J.
Dateof Investment
2.
J.:
4.
).
6
4.
5.
doesnot bestowanylegalright.The enterpriseis requiredto seek
Note : Theissueof this acknowledgement
requiredunderstatutoryobligationstipulatedunderthe lawsof Cental
requisiteclearance4icence/permit
GovemmenustateGovemment/LlTAdministation/Courtorders.DDMMyyyy
Dateof changeof Categoryfrom Micro/Smallto
Small/\4ediumor Vice Versa
M
6.
Dateof Issue
7.
Natureof Activity
(Manufacnring-1, Services-2)
Categoryof EnterPrise
(Micro-l, Small-2,Medium-3)
8.
9.
Entrepreneur'sMemorandumNumber
F ftrl
W
T
n
tI
Pafl
il
boxesarefor
Tenitorycode,nexttlueeboxesarefor Districtcode,sixtttandseventh
(Firsttwo boxesarefor StateAlnion
or serviceandseventhbox for indicatingmicroor smallor
(sixttrbox for indicatingmanufacturing
categoryof enterprise
number)
Memorandum
tneaium)andlasifiveboxesarefor Entepreneurs'
Date:
Place:
Signature
With OfftceSeal
FormNo.
PART II
(To be filled up andsubmittedto the District krdustriesCentreafter commencement
of productivity/activity)
I\IEEDTO BEFILLED ONLYTO TI{E EXTEM THAI TIIE
GHE ROWSWHICHHAYEBEENREPREATED
VARY
FROMTHOSEIN PARI T)
DETAILS
ON
COMMENCEMENT
ACTUAL
(Part
I)
Memorandum
Number
L Entrepreneurs
W
to l-tfol
m
D D M M Y Y Y Y
II. Date of Issue
M M
IIL Month of Commencementof Production/activity
1. Name of Applicant
2. a) Addressof Communication
PIN
i) TelephoneNumber
ii) Fax Number
iii) Cell PhoneNumber
iv) E-mail
V) Web-site
b) PermanentResidentialAddress(Main Applicant)
PIN
i) TelephoneNumber
ii) FaxNumber
iii) Cell PhoneNumber
Y
b
iv) E-mail
V) Web-site
3. Name of Enterprise
4. Locationof Enterprises
i) Village/ Town
Village/TownCode
ii) Tehsil/Taluka/\dandal
Tehsil/Taluka/Ivlandal
Code
iii) District
N A S H
K
District Code
iv) State
M A H A R A S H T R A
StateCode
v) PIN Code
vi) Area(Rural-1,Urban-2)
5. Categoryof Enterprise
(Micro-l, Small-2,Medium-3)
6. Natureof Activity [Tick AppropriateBox(es)]
i) Manufacture
ii) Service
r
l
T
T
7. Natureof Operation
Casual-3)
1, Seasonal-2,
@erennial8. Whethertheunit is an ancillarY
(Ycs-l,No-2)
9. Month of Installationof Plant andMachinery
T
T
M
M
10. WhethertheUnit is registeredunderFactoryAct
2m(i/2m(iill, 85(iy85(ii!2,notregistered-3)
(UnderSection
of Organisation
11.Tpe
-(ProprietoryCooperative'4,
Partrership-3,
Family-2,
1,HinduUndivided
Others'8.)
privateLimitedCompany-5,
Self'HelpGroup-7,
PublicLimitedCompany-6,
12.
Y
Y
Y Y
n
l
Activity
a) Main Manufacturing/Service
Code(NIC 98*)
to be provided
to be Manufactured/Service
b).Products
i) Name
Code(ASICC2000*)
ii) Name
Code(ASICC2000*)
iii) Name
Code(ASICC2000*)
iv) Name
Code(ASICC2000*)
v) Name
Code(ASICC2000*)
as per classificationqpecifiedfrom time to time by ofnce of
(*) Codesfor activitiesand productVservices
or the
commissioner(SmallScaleIndusties),to be filled in by the Disrict IndustiesCente
theDevelopment
officewherettreEntepreneurs'Memorandumis submitted'
(Add Additional sheetfor morc products)
13. (A) Invesfrnentin fixed assets[Rupeesin Lakh]
i) Land(Owned4llRented-02/Leased-03)
Value*
ii) Building(Owned-01/Rented-02/Leased-03)
Value*
iii) PlantandMachinery
Value*
(In caseof manufacturingenterprise)
(in Rs.)
Tumover
18. TotalAnnual
(If lessthanoneyearof operation,
tumover)
thenexpected
19. Export(in any)(in Rs.)
(of all Parfrrers/Directors
if needed)
Useseparate
sheets,
of theorganisation.
20. Enhepreneurs'Profile
a) Name
f,
i) Male(M)/Female(F)
I
(5)
(4)Physically
Challenged
ii) SC(l) / ST/ (2)OBC(3)/ Others
f,
Level
iii) Knowledge
PostGraduate-3,
Graduate-2,
1,Management
Graduate[Technical
AnyotherLower-6]
Under-Graduate-5,
otherGraduate-4,
'iv)
(in Rupees)
Equityparticipation
(In Percentage
of totalequity)
[]
(Yes-l,No-2)
Enterprises
v) Stakein otherManufacturing
(AddAdditionalSheet,
If needed)
T
D D M M Y Y Y Y
of Production/Activity
21. Dateof Commencement
Date:
Place:
of theApplicant/Authorised
Penon]
[Signature
Director]
lNameof theProprietor/Partnerfvlanagement
wherever
while
ResolutiorL
applicablg
Resolutior/Society
copyof Powerof AttomeyiBoard
a self-certified
a) Enclose
Penon.
DirectororAuttrorised
sigringasPartrer/lvlanaging
in case
ofAssociation
ofAssociation/futicles
Deed/lvlemorandum
copyof thePartrership
a certified/notariznd
b) Enclose
of MediumEnterprises.
Undertaking
........is frueand
in FormNo. .............
in thememorandum
fumished
Thisis to certiffthattheinformation
/ License/ pennitfrom
approval/ consent
andbelief.I / Wehaveobtained
conectto thebestof my knowledge
asstratutory
/ tn Administration
/ Strate
Government
of CentralGovernment
Ministry/ Department
theconcerned
requirements.
Date:
Place:
of theApplicant/AuthorisedPerson]
[Signature
FormNo.
DISTRICTINDUSTRIESCDNT}D,N AS}IIK
(PART-Ir)
ACKNOWLEDGEMENT
l.
1
lWs.
for a
hasfiled memorandum
(Manufacturing/service)
Enterpriseattheaddress
forthe item/items
indicatedbelow&actMtyhascorlmencedfromthedate
No. asbelow :
& allocated.Entrepreneurs'Memorandum
to beprovided
Detailsof item/itemsto be manufactured/service
Items of manufactu
asstatedinFormNo.
Capacityin case
of manufacture
Initial date of
production/
commencement
of sewice
(Add additionalsheetif required)
Detailsof Plant& Machineryasper date-wiseinvestrnent
Investmentin Plant & MachinerylEquipments
Sr.No.
1.
Dateof Investment
2.
J.:
4.
).
6
4.
5.
6.
8.
9.
doesnot bestowanylegalright.Theenterpriseis requiredto seek
Note: Theissueof this acknowledgement
requisiteclearance/licencdermitrequiredunderstatutoryobligationstipulatedunderthe lawsof Cental
y Y Y
Govemment/StateGovemmentruTAdministation/courtorders.
D DMMy
Dateof changeof Categoryfrom Micro/Smallto
Small/Mediumor Vice Versa
M
Dateof Issue
T
T
Natureof Activity
1, Services-2)
(ManufacturingCategoryof Enterprise
(Micro-l, Small-2,Medium-3)
Entrepreneur'sMemorandumNumber
f0 [tr]
W
m
Paxl
II
boxesarefor
Tenitorycode,nextthreeboxesarefor Distict code,sixthandseventh
(Firstnvoboxesarefor StateA]nion
or smallor
micro
indicating
or serviceandseventhbox for
(sixttrbox for indicatingmanufacturing
categoryof enterprise
number)
*.aiut) andlastfive boxesarefor Entepreneurs'Memorandum
Date:
Place:
Signature
With OffrceSeal
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