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MSME Declaration Template 3

This document contains a form for a company to confirm whether it falls under the Micro, Small and Medium Enterprises Development Act of 2006. It asks the company to select whether it is a micro, small, or medium enterprise. For options a or b, additional documents are required including the PAN card, MSME/Udyog Aadhaar certificate, last financial returns, and a notarized affidavit confirming the company's status and investment amounts. The affidavit must be signed and notarized on a stamp paper of Rs. 10 or more.

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5K views3 pages

MSME Declaration Template 3

This document contains a form for a company to confirm whether it falls under the Micro, Small and Medium Enterprises Development Act of 2006. It asks the company to select whether it is a micro, small, or medium enterprise. For options a or b, additional documents are required including the PAN card, MSME/Udyog Aadhaar certificate, last financial returns, and a notarized affidavit confirming the company's status and investment amounts. The affidavit must be signed and notarized on a stamp paper of Rs. 10 or more.

Uploaded by

G&G CONSULTANCY
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Provisions Confirmation: Confirms applicability of provisions from the Micro, Small and Medium Enterprises Development Act, 2006 with related form details.
  • Affidavit: Contains an affidavit declaration for micro-enterprise registration and relevant business details.
  • Attestation Requirement: Outlines the stamp paper and attestation requirements by a Notary Public for the affidavit.

[To be printed in your company letter head]

1. I/We confirm that the provisions of the Micro, Small and Medium Enterprises
Development Act, 2006 are applicable to us and our organization falls under the
definition of:
a. [ ] Micro Enterprise
b. [ ] Small Enterprise [Please tick the applicable option]
c. [ ] Medium Enterprise

MSME / Udyog Aadhaar Registration Number: _____________________________________

2. [ ] None of the provisions of the Act is applicable to us Date: / /


a. Entity Name (Vendor Name): __________________________________________
b. Name and Title of Employee Completing form: _________________________________
c. Contact number & email Id of the Employee completing form:
_______________________

Note
Additional documents required in case Clause No 1 (a) or (b) is applicable:
1. PAN Card
2. Copy of the MSME / Udyog Aadhaar certificate
3. Certified copy of last filed financial returns
4. Affidavit as attached as Annexure 1
ANNEXURE 1
AFFIDAVIT**

I______________________________________ S/O _________________________________________


Managing Director/Director/Proprietor/Partner, * M/s. ______________________________
______________________ with their Regd. Office at
______________________________________
& Factory located at
_________________________________________________________________
with permanent small/micro–Enterprise Registration No._______________dt. __________
Do hereby solemnly affirm and declare as under:
i. The company has been a small/micro-Enterprise unit as per the Govt. Of India
definition; and has been functional & in production at the time of GS1/UPC
registration and as on date.
ii. The company continues to be a small/micro-Enterprise unit, and functional &
in production as on date.
iii. As per books of accounts, the total investment (original purchase value) in plant
andmachinery in the Company as on _________________________________________
is Rs. ________________ (Chartered Accountant's Certificate dated ____________
to this effect is attached)

Signed on this day of ________________________

DEPONENT
VERIFICATION:
Verified that the contents of the affidavit are true to the best of my knowledge and
belief.
DEPONENT
Date:
Place:
Note: - *Strike out whichever is not applicable.
**On a stamp paper (of Rs. 10/- min) duly attested by Notary Public (duly affixed with
Notarial Stamp; and with Notary Seal; and Notary Registration number).

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