FORM NO:
006124631
Date of Online Filing :
23 Jan 2014
LETTER
Sir/Madam
"EM PART-I"
You have successfully filed an on-line application for Entrepreneur Memorandum part-I for registration of your Micro/Small/Medium scale unit. You may kindly print the on-line application (3 copies) and send the signed copies of application along with required attachments as indicated below a) Enclose a self-certified copy of Power of Attorney / Board Resolution / Society Resolution, wherever applicable, while signing as Partner / Managing Director of Authorised Person. b) Enclose a certified/notarized copy of the Partnership Deed / Memorandum of association / Articles of Association in case of Medium Enterprises. You may kindly note that your on-line filed application will be processed only after receipt of signed copies of application (3 copies) along with required attachments in the concerned GM, DIC office. You are requested to send the signed copies of on-line filed application within 30 days. Thanking you.
General Manager, District Industries Centre, Balanagar X Road, Balanagar, Rangareddy. eMail: gm_dic_rr@[Link] Phone No: 040-23441644
To,
Name : Door No : Street : Village / Town : Mandal : District : State : Pincode :
PUTTAPAGA
RADHA,
BACKSIDE OF SRI GAYATH BAVANI NAGAR COLONY TUKKUGUDA, MAHESHWARAM RANGAREDDY ANDHRAPRADESH
FORM NO:
006124631
Date of Online Filing :
23 Jan 2014
ENTREPRENEURS MEMORANDUM FOR SETTING UP MICRO,SMALL OR MEDIUM ENTERPRISE
PART-I
1.
NAME OF APPLICANT SURNAME MIDDLE NAME LASTNAME RADHA PUTTAPAGA
2. (a) ADDRESS OF COMMUNICATION BACKSIDE OF SRI GAYATHRI TECHNO SCHOOL,BAVANI NAGAR COLONY,TUKKUGUDA,MAHESHWARAM,RANGAREDDY,ANDHRAPRADESH, (i) TELEPHONE NUMBER
(ii) FAX NUMBER (iii) CELL PHONE NUMBER (iv) E-MAIL (v) WEB-SITE (b) PERMANENT RESIDENTIAL ADDRESS (MAIN APPLICANT) BACKSIDE OF SRI GAYATHRI TECHNO SCHOOL,BAVANI NAGAR COLONY,TUKKUGUDA,MAHESHWARAM,RANGAREDDY,ANDHRAPRADESH, (i) TELEPHONE NUMBER
(ii) FAX NUMBER (iii) CELL PHONE NUMBER (iv) E-MAIL
3.
NAME OF PROPOSED ENTERPRISE (if decided) M/S. KOTHAGUDA RURAL HEALTH CENTRE
4.
PROPOSED LOCATION OF ENTERPRISE (i) VILLAGE / TOWN / MUNCIPALITY CODE (ii) TEHSIL / TALUK / MANDAL CODE (iii) DISTRICT CODE (iv) STATE CODE (v) PIN CODE (vi) AREA (RURAL-1, URBAN-2) 1 2 Rangareddy 006 ANDHRAPRADESH 28 Kandukur 0034 Kandukur 00583100 SURVEY / PLOT NO 62,63
5.
CATEGORY OF ENTERPRISE (MICRO-1, SMALL-2, MEDIUM-3)
FORM NO:
006124631
Date of Online Filing :
23 Jan 2014
6.
NATURE OF ACTIVITY (i) MANUFACTURE (ii) SERVICE Y 1 2 Mar/2014 (MM/YYYY)
7. 8. 9. 10.
NATURE OF OPERATION (Perennial-1, Seasonal-2, Casual-3) WHETHER THE UNIT WILL BE AN ANCILLARY (Yes-1, No-2) PROPOSED SCHEDULE OF INSTALLATION OF PLANT AND MACHINERY(MM/YYYY) TYPE OF ORGANIZATION (PROPRIETARY-1, HINDU UNDIVIDED FAMILY-2, PARTNERSHIP-3, CO-OPERATIVE-4, PRIVATE LIMITED COMPANY-5, PUBLIC LIMITED COMPANY-6, SELF-HELP GROUP-7, OTHERS-8) (a) MAIN MANUFACTURING / SERVICE ACTIVITY NAME ACTIVITIES OF INDEPENDENT DIAGNOSTIC / PATHOLOGICAL LABORATORIES CODE(NIC 2004*)
11.
(b) PRODUCTS TO BE MANUFACTURED / SERVICE TO BE PROVIDED 1 NAME X-RAY CLINIC CODE(ASICC 2000*) (*) Codes for activities and products / services as per classification specified from time to time by the office of the Development Commissioner (Small Scale Industries), to be filled in by District Industries Centre or the office where the Entrepreneurs' Memorandum is to be submitted. 12. (a) (i) PROPOSED INVESTMENT IN FIXED ASSETS [Rupees in lakh] LAND (OWNED-01/RENTED-02/LEASED-03) APPROXIMATE VALUE * (ii) BUILDING (OWNED-01/RENTED-02/LEASED-03) APPROXIMATE VALUE * (iii) PLANT AND MACHINERY (In case of manufacturing enterprise) (iv) EQUIPMENT VALUE* 89.50 VALUE* 0 0.00 0 0.00 0.00 3 3
(In case of service enterprise) (v) FOREIGN EQUITY, IF ANY 13. VALUE* 0.00
INSTALLED CAPACITY (proposed) PER ANNUM
FORM NO:
006124631
Date of Online Filing :
23 Jan 2014
(i) PLANT A SNo 1 PRODUCT NAME X-RAY CLINIC QUANTITY 0.00 UNITS UNITS
(ii) PLANT B SNo PRODUCT NAME QUANTITY UNITS
14.
POWER LOAD (ANTICIPATED)
H.P / K.W.
QTY 1.00 HP
UNIT
15.
(a) (i) OTHER SOURCE OF ENERGY / POWER [IF REQUIRED] (NO POWER NEEDED-1, COAL-2, OIL-3, LIQUID PETROLIUM GAS-4, ELECTRICITY FROM GRID-5, ELECTRICITY FROM GENERATOR-6, NON-CONVENTIONAL ENERGY-7, TRADITIONAL ENERGY/FIREWOOD-8) (ii) If no power required, specify reasons;
(b) INDICATE ANNUAL REQUIREMENT SNo. SOURCE OF ENERGY QTY UNIT
16.
EXPECTED EMPLOYMENT (i) MANAGEMENT & OFFICE STAFF
(No.s) 1 2 3
(ii) SUPERVISORY (iii) WORKERS
17.
ENTREPRENEUR'S PROFILE (OF ALL PARTNERS / DIRECTORS OF THE ORGANISATION-USE SEPARATE SHEETS, IF NEEDED) (a) (i) NAME MALE (M) / FEMALE (F) PUTTAPAGA RADHA F 1 5
(ii) SC(1) / ST(2) / OBC(3 ) / OTHERS(4) / PHYSICALLY CHALLENGED(5) (iii) KNOWLEDGE LEVEL [TECHNICAL GRADUATE-1, MANAGEMENT GRADUATE-2, POST GRADUATE-3, OTHER GRADUATE-4, UNDER-GRADUATE-5, ANY OTHER LOWER-6] (iv) EQUITY PARTICIPATION (in Lakhs) (Percentage of total equity ) (v) STAKE IN OTHER MANUFACTURING ENTERPRISES (Yes-1, No-2 )
89.50 100.00 2 %
FORM NO:
006124631
Date of Online Filing :
23 Jan 2014
(DD/MM/YYYY) 18. EXPECTED SCHEDULE OF COMMENCEMENT OF PRODUCTION / ACTIVITY
31/03/2014
DATE : PLACE : [SIGNATURE OF THE APPLICANT/AUTHORISED PERSON] NAME OF THE PROPRIETOR/PARTNER/MANAGING DIRECTOR (a) Enclose a self-certified copy of power of Attorney/Board Resolution/Society Resolution, wherever applicable, while signing as Partner/Managing Director or Authorised Person. (b) Enclose a certified/notarized copy of the Partnership Deed/Memorandum of Association/Articles of Association in case of Medium Enterprises. ____________________________________________________________________________________________
Undertaking
This is to certify that the information furnished in the memorandum in Form No. 006124631 is true and correct to the best of my knowledge and belief. DATE : PLACE : [SIGNATURE OF THE APPLICANT / AUTHORISED PERSON]
