SPECIMEN APPLICATION FORM
FOR ALLOTMENT OF LAND IN THE DEVELOPMENT
AREA/DEVELOPMENT PLOT ON HIRE PURCHASE
1.
Name of the applicant and full permanent
address :
2.
Present address
:
3.
Name and address of the existing/proposed
industry :
4.
Items manufactured/proposed to be
manufactured in
the Industrial unit with quantity :
5.
Nature and quantity of raw materials used /
proposed to be
used
a)
Imported
b)
Indigenous
:
6.
Details of the plot required
a)
Plot No.
:
b)
Extent
:
c)
S.No.
:
d)
Name of village
:
e) Name of Taluk
:
7.
If existing Industry present location and
reasons for
changing the same
:
8.
The total estimated cost for
a) Building
b) Machinery
and equipment
i)
Indigenous
ii)
Imported
c) Working
capital
9.
Nature of management
:
a)
Proprietary
:
b)
Partnership
:
c)
Registered
company
:
d) Industrial
co-operative
:
10. The
position held by the applicant in undertaking
and the name of the
person who is authorised to
execute the
agreement on behalf of the organisation
:
11. No.
and date of chalan to prove remittance of
earnest money
:
I have read
and understood the rules prescribed for hire purchase of plots in the
development plot of Kerala State as per G.O. No. and I hereby declare to
abide by them
Place:
.........
Signature of the Applicant
Date: