M-SIPS Initial Application Form

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. Application details : a. Name b. Legal Status M-SIPS Initial Application Form Certified copy of memorandum and article of association or equivalent registration form to be attached) c. Address d. Phone e. Email f. PAN g. Nature of current business h. Turnover i. Net worth j. Achievements in activities proposed to be undertaken k. Brief profile of Chairman, CEO and CXO l. Shareholding details CA certified copy of PAN CA certified copy of Service tax CA certified copy of Central Excise certificate CA certified copy of Annual Reports for three years CA certificate on net worth for individual applicant Self certified brief Bio data of Chairman, CEO and CXO Report of independent equity analyst s report( for publicly listed companies) not older than months from latest financial results. CA certificate showing shareholding patterns( no. of shares and investments) if company registered under company act or else Equivalent document disclosing nature of control and ownership for other entities. m. Promoters Details (i) In case the applicant company registered in India, details of each of the promoter holding stake greater than or equal to 0% in applicant entity: II. Address, III. Phone, IV. Email, V. PAN (ii) In case of other legal entity, details of main promoters to be furnished: II. Address, III. Phone, IV. Email, V. PAN

Copy of PAN for promoters/promoter companies of the applicant. Document showing nature of control of the promoter and also his ownership for other entities. n. Reference details (Applicant has to provide details of the following for reference( Name, official designation, address, email, telephone, fax details of each of the ) : Principal Lead Banker II. official designation, III. address, Another Banker Dealers:... Suppliers:... VI VIII. official designation, IX. address, X. email, XI. telephone, XII. fax o. Pending legal cases( applicant to provide details of all pending cases) Certificate from Company Secretary/Board Director in the case of Company and Secretary for society on pending legal cases Self Certificate that the applicant is not blacklisted by any Government Department. p. Details of agreement between consortium partner: Roles and responsibilities of each of the partner Nature of agreement and stake Self-certified copy of agreement. q. Key personnel details: Contact details of senior employees II. official designation,

III. address, r. Contact details of authorised signatory II. official designation, III. address, s. Financial details: I. Revenues (in crores) : Key Product wise SNO FY(last years) Product Revenue Key Geographic Area wise SNO FY(last years) Geographical Area Revenue II PAT & PBT Key Product wise SNO FY(last years) Product PAT PBT Geographic Area wise SNO FY(last years) Geographical Area PAT PBT III Details of Funds Received

SNO FY(last years) Name of Agency Institute Funds Received Equity Debt IV Key financial indicators SNO FY(last years) ROI ROCE Earnings Before Interest Tax V Funds raised for capital projects SNO FY(last years) Capital Project Funds Raised VI Major investment / fund raising / public listing plans SNO FY Fund Raising Current Status VIII Details on lines of credit (no. of banking relationships, banking facilities, debt and equity market position) VIII Capital market data with last months stock price movement, if applicable IX External credit ratings (year, agency, rating assigned) (if applicable) ( pl refer para. to.0 of Annexure I MSIPS guidelines). Electronics Manufacturing Cluster details : A. Name B. Address C. DeitY notification reference number:

. Project proposal details: DPR a. Name of vertical: b. Project Description: I. Name II. Nature III. Scope IV. Objective c. Entity Structure under which the project is to be undertaken I. Entity name II. Legal Status III. Shareholding patterns IV. Details of agreement signed with partners V. The roles and responsibilities between the partners d. Technology proposed e. Intellectual property status f. Details of collaborative arrangements or tie-ups or working arrangements with other firms for technology g. Details of owner of Technology I. Name II. Registered address III. Contact details IV. Top Management details V. Summary of experience in the products and markets being served VI. Status of existing patents, copyrights and trademarks. h. Nature of agreement of applicant with technology owner. i. Source of product design j. Potential Scope and plan for technology upgrades including back-up R& D. k. Summary of results of feasibility studies conducted for the project, if any. I. Target market segments and market sizes II. Proposed product features and characteristics III. Competitive differentiation IV. Planned mix of export and sales in the domestic market V. Distribution channels VI. Potential customers to be targeted and expected revenues from major customers VII. VIII. Market size and growth for the proposed technology Summary of internal and external market research reports supporting the marketing plan

l. Operations and facilities analysis : I. Location proposed (complete address) II. Whether the location is confirmed or not. III. If not confirmed, mention the options under considerations IV. Level of readiness of the site V. Whether located in SEZ or non-sez VI. Building Plan VII. Size VIII. Infrastructural requirements IX. Details of proposed occupancy( self-owned or leased) X. Project plan with implementation schedule including Key Milestone including proposed date of commencement of operation. XI. Proposed production capacity XII. Raw material availability XIII. Quantum of water, electricity or gases required for procuring the same XIV. Labour requirements (provide analysis of specialized manpower and training needs XV. Opportunity to expand operations in future years m. Project cost I. Total estimated cost of project( Rs Cr.): II. Size of overall investment ( phase-wise in case of multiphase project) III. Investment by each of the applicant ( phase-wise in case of multiphase project) in case of joint application. IV. Outlay for technology V. Capital expenditure details VI. Sources of funding : Internal accruals/equity/government assistance/term debt/working capital loans /any other VII. Details of Principal Banker for the investments VIII. Investor details for each source of funds IX. Financial assistance sought from govt. of India n. Risk analysis and Sustainability Plan : Submitted/not submitted Provide copy of DPR ( DPR should contain project description, applicant entity structure, roles and responsibility, their stake, technology proposed, its ownership proposed project location,project timelines, forecasted returns, ROI and Breakeven estimate, P & L, Balance sheet and cash-flow till 0 years, estimated running operating expenses for 0 years, Key financial indicators like NPV,IRR, estimated variable cost per unit for 0 years, detailed financial sensitivity analysis like stress test for key success indicators, key assumptions for financial projections, detailed supporting financial statements, detailed assessment of risk analysis and sustainability plan, informations on licences, permits and rd party approvals necessary to execute the project alongwith the proposed process and timelines for obtaining approvals, entire proposed project timelines). a copy of Feasibility study MOU agreement between the partners in case applicant is a consortium of

legal entities Documents showing ownership and possession of land Copy of Industrial Entrepreneurs Memorandum (IEM) in DTA or approval under SEZ scheme. Technology details and Copy of technology agreements with technology provider Provide Details of proposed project implementation first phase ( for applicants who propose a multi-phase project) Investment details of first phase of implementation.: a. Investment by each of the applicant in case of joint application: b. Details of expenditure in items of Capital expenditure c. Details of expenditure in items of Capital expenditure by each of the applicant in case of joint application d. Sources of funding : Internal accruals/equity/government assistance/term debt/working capital loans /any other e. Details of Principal Banker for the investments f. Investor details for each source of funds g. Financial assistance sought from govt. of India h. Risk analysis and Sustainability Plan : Submitted/not submitted i. Details of Financial Closure: I. Debt II. Equity III. IV. Promotors contribution Details of financial Institution providing Debt and equity Name official designation, address, email, telephone, fax Details of equity providers Name, official designation, address, email, telephone, fax To provide project report for st phase of implementation Financial Closure document and details 5. Financial Closure Details A. Debt B. Equity C. Promotors contribution D. Details of financial Institution providing Debt and equity

II. official designation, III. address, E. Details of equity providers II. official designation, III. address, Copy of Bank/FI appraisal note Company Secretary certified copy of the sanction letter and the term loan agreement of the debt. Company Secretary certified copy of Board Resolution for equity for companies or equivalent for other legal entities/proof of equity having been brought in. Proof of equity having been brought in as per the project schedule. In case of term loan as per the term loan agreement. 6. Initial Application fee DD.