APPENDIX-14-1-A. APPLICATION FOR SETTING UP EOU/SEZs or UNITS IN SPECIAL ECONOMIC ZONE

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APPENDIX-14-1-A APPLICATION FOR SETTING UP EOU/SEZs or UNITS IN SPECIAL ECONOMIC ZONE Note 1. Please see Para 6.3.1 to 6.3.3. of the Chapter 6 & Para 7.7.2 to 7.7.4 of Chapter 7 of the Handbook of Procedures (Vol.-I) 2 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. 3. 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 THE APPLICATION IS 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 alongwith 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 RENEWEL/ EXTENSION OF LOP/ BROAD BANDING ETC.) For Official use only Application No. Date / / Date Month Details of Bank Draft Amount Rs. Draft No. Draft Date Drawn on (Name of the Bank) Payable at 1

I. 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 Office for others) Pin Code Tel.No. Fax No. Permanent E-mail Address Web-Site, if any Passport No., if any Name of Bank with Address & a/c No. Digital Signature (Yes/No) Income Tax PAN No. The name and Address of each of the Director/Partner 1. 2. 3. 4. 5. 6. II. NATURE OF THE APPLICANT FIRM: (Please click/tick the appropriate entry) Government Undertaking Public Limited Company Private Limited Company Proprietorship Partnership Others (Please Specify) Note:- copy of the certificate of incorporation alongwith Article of Association and Memorandum in case of companies and Partnership deed in case of partnership firms may please be attached III. INDICATE WHETHER THIS PROPOSAL IS FOR: (Please click/tick the appropriate entry) Establishment of a New -Manufacturing Undertaking -Services Effecting Substantial Expansion Manufacturing of New Product Conversion of (i) existing DTA units in to EOU/SEZ (ii)existing STP/EHTP to EOU/SEZ (In case of conversion, please attach fact sheet as per Annexure) 2

IV. (1) Location of the proposed undertaking Full Address Pin Code 2) ONLY FOR PROJECTS UNDER EOU SCHEME (In case the unit is proposed to be located on leased premises, then lease should be obtained from Government or any undertaking/authority of Government. 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 tick the appropriate entry) No Yes I yes, indicate category b) Indicate whether it is within 25 Kms from the periphery of the standard urban area limit of city having population above on million according to 1991 census. Yes No c) Is it locate din an Industrial Area/Estate designated/set up prior to issuance of Notification No.477(E) dated 25 th July, 1991. Yes No d) If not, does it come under the category on non-polluting industries as notified by the Govt. Yes No V. 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 HD Code No.) (Note required for service unit) VI. PRODUCTION (In case of more than one item, supplementary sheets may be used) Quantity (Unit = ) Value in Rupees (Note required for service unit) 1 st year 2 nd year 3 rd year 4 th year 5 th year 3

VII. INDIGENOUS REQUIREMENT: a) Capital goods b) Raw material, components, consumables, packing material, fuel etc. during the period of 5 years TOTAL (Value in Rupees) VIII FOB VALUE OF EXPORTS (1 $ = Rs. ) Rupees (lakhs) US $ (thousand) 1 st year 2 nd year 3 rd year 4 th year 5 th year IX INVESTMENT a) Land b) Building c) Plant and machinery i) Indigenous ii) Imported (CIF Value ) (iii) Total (i)+(ii) d) Details of source(s) of finance, (both Indian as well as foreign) for the above investments Rs. In lakhs US $ thousand X WHETHER FOREIGN TECHNOLOGY AGREEMENT IS ENVISAGED Yes No (i) Name and Address of foreign collaborator (ii) Terms of collaboration Rupees lakhs (Gross of Taxes) a) Lumpsum payment 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 s) 4

XI EQUITY INCLUDING FOREIGN INVESTMENT US$ (thousand) Rupees (in lakhs) Existing Proposed Existing Proposed (i) 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 Rupees (In US (thousand) lakhs) (a) Foreign holding 100.00 (b) Non Resident Indian 100.00 Company/Individual holding (i) Repatriable 50.00 (ii) Non-repatriable 50.00 (c) Resident holding (d) Total (a+(b(i)+b(ii)+c) equity (e) External commercial borrowing FOREIGN EXCHANGE BALANCE SHEET XII. XIII. (i) (ii) (iii) (iv) (v) (vi) (vii) FOB Value of exports in first five years Foreign Exchange Outgo on Import of Machinery Import of raw materials and components Import of spares and consumables Repatriation of dividends and profits to foreign collaborators Royalty Lump sum know-how fee Design and Drawing fee (viii) Payment of foreign technicians 1st 2 nd 3 rd 4 th 5 th Rs. Lakhs Total US$ Thous. 5

(ix) (x) (xi) (xii) Payment on training of Indian technicians abroad Commission of export etc. Foreign Travel Amount of interest to be paid on external commercial borrowing/ deferred payment credit (Specify details) (xiii) Any other payments (Specify details) Total (i) to (xiii) Net Foreign Exchange Earnings in five years XIV REJECTS (Only for EOU manufacturing units) Generation of Rejects/Sub-standard finished goods % Quantity (Unit (In case rejects are more than 5% estimated percentage with justification may be given) = ) Value (in Rs. Lakhs) XV EMPLOYMENT (All figures in number) a) Supervisory b) Non-supervisory Men Women Men Women Existing Proposed XVI NET FOREIGN EXCHANGE EARNING Average NFE on FOB value of exports in 5 years XVII MARKETING a) Whether marketing tie-up/bye-back Yes No envisaged/ finalized (attach documents, if any) b) Destination of exports (in percentage) G.C.A. R.P.A % % 6

INFORMATION (i) Any special features of the project proposal which you want to highlight (Please attach the project report, for new units) (ii) (a) Whether the applicant has been issued any Industrial license or LOI/LOP under EOU/SEZ/STP/ (ii) (b) EHTP scheme. If so, please give full particulars especially reference number, date of issue, items of manufacture and progress of implementation of each project Whether the applicant has submitted any other application for LOI/LOP which is pending with the Board of Approvals. If so, please give particulars like reference number, name under which application made, items of manufacture etc. Whether the applicant or any of the partners/directors who are also partners/directors of another company or its associate concerns are being proceeded against or have been debarred from getting any Lincese/letter of Intent/Letter of Permission under the Export and Import (Control) Act, 1947/Foreign Trade (Development and Regulation) Act, 1992/FEMA/Custos/Central Excise Act. Place Date Official Seal/ Stamp Signature of the applicant Name in Block Letters Designation Tel No. E-Mail address Website, if any Full Residential Address UNDERTAKING I/We hereby declare that the above statements are true and correct to the best of my/our knowledge and belief. I/We will abide by any other condition, which may be stipulated by the concerned Development Commissioner. I/We fully understand that any Permission Letter 7

granted to me/us on the basis of the statement furnished is liable to cancellation or any other action that may be taken having regard to the circumstances of the case if it is found that any of the statements or facts therein are incorrect or false. An affidavit duly sworn in support of the above information is enclosed. Place Date Official Seal/ Stamp Signature of the applicant Name in Block Letters Designation Tel No. E-Mail address Website, if any Full Residential Address SOME IMPORTANT GUIDELINES 1. Additional Information may be furnished by existing domestic units seeking conversion into the EOU/SEZ Scheme as per annexure. 2. Normally raw material tie-ups are not insisted upon but this may be necessary in cases, such as granite/marble/sandstone products where availability of raw materials is contingent upon Government leases etc. 3. Normally lumpsum amount up to US $ 2 Million and 8% royalty (net of taxes) as amended from time to time over a period of five years from the commencement of production is allowed as per the current EOU/SEZ Scheme on account of foreign technology agreement as per the norms of Department of Industrial Policy and Promotion. In addition selling agency commission is permitted as per RBI norms. 4. Cases involving high outgo of foreign exchange for capital goods and raw materials, the Government prefers raising of funds through external commercial borrowings. 8

ANNEXURE PROFORMA TO BE FILLED IN BY THE EXISTING DTA UNITS SEEKING CONVERSION INTO THE EOU/SEZ SCHEME a) Whether conversion of DTA Unit into the EOU/SEZ has been sought for the full existing capacity of the unit or the proposal is for partial conversion.(please give details of the existing capacity etc.) b) Whether any expansion of the DTA unit proposed to be converted into EOU/SEZ has bee envisaged, if so the extent thereof.(please give details of the existing capacity and the enhanced capacity etc). c) What is the level of existing exports of the unit proposed to be converted into EOU/SEZ. (Please give details of export performance item-wise for a minimum of three previous years) d) Whether the DTA unit is already under obligation to export, under: i) Advance Licensing Scheme; ii) Import of machinery under EPCG scheme; iii) Any other Scheme. (Give all relevant details including total E.O. imposed, the E.O. discharged till date etc.) e) Whether your unit is registered with the Customs or E authorities. (Please give details viz. Reg. No., date etc.) f) Are you agreeable to have your whole unit customs bonded as required under the EOU/SEZ scheme? g) Whether you are a merchant exporter or a manufa exporter.(please give details) h) What is the age(year of manufacture)and residual life of items/ machinery already installed in your unit, whether they are imported or indigenous.(please attach separate sheets giving item-wise details with value of the new CG as well as existing value of machinery presently installed). Place Date Signature Name of the applicant Address of the applicant 9