Application_formApplication ID:(For office use)APPLICATION FORM
FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTERS EMPLOYMENT
GENERATION PROGRAMME (PMEGP)Preference for sponsoring agency of the
project to Bank:(mark )KVICKVIBDICRURALURBANTO.District Industries
CenterState:1Name of the Applicant/Institution7/2/742Date of
Birth:DDMMYYYYAge ( in
Years)27197439Male23SexMaleFemaleFemale4Father's/Spouse's/Contact
person Name (if Institution):Khadi & V.I.
CommissionKVIC45Communication Address:Khadi &
V.I.BoardKVIBDistrict Industries CenterDIC (Rural)District
Industries CenterDIC
(Urban)Taluk/Block:District:PinRural2Email:Contact No:Urban6Address
of the Proposed location of
Unit:RuralUrbanNo1YesTaluk/Block:District:Pin:SC87Name of the
preferred Bank Name & Address in the Area for Project
Sanction:STOBCPHCTaluk/Block:Ex- ServicemanDistrict:Branch
Code:MinorityHill Boarder
Area8QualificationGeneralAcademicTechnicalUnder
8thManufacturing29Whether Entrepreneur Development programme (EDP
at least 2 weeks) under gone: (mark )YesNoServiceName & Address
of Training InstitutePeriod of TrainingCertificate Issue
Date2FromToUnder 8th8th Pass10th Pass12th Pass10Whether the
applicant belongs to (mark )GraduateSCSTOBCPHCEx- Service
manMinorityHill Boarder AreaGeneralPost GraduatePhDOwn211Whether
the project (mark )Manu-facturing UnitService UnitRented12Name of
the project / business activity proposed :Leased13Amount of loan
required (in Rs.)Building TypeCapital Expenditure
LoanWorkshedBuilding etc.Machinery/ Equipment/FurniturePre
OperativeCostWorking Capital / Cash Credit
LimitTotalRented0000014Details of earlier or current Loan/Grant and
subsidy availed from Central/State Govt. Scheme/ or any other
Similar Scheme.Activity of the Project with AddressAmountYear of
SanctionI certify that all information furnished by me is true; and
that I and any of my dependent have not borrowed any money under
subsidy linked scheme from any Central / State Government or bank
for establishing any such projectPlace:Date:Signature of the
ApplicantFor Official Use only:(Rejected / to be placed before
District Task force Committee)Reason (if Rejected):Place:Signature,
Name & Designation of OfficerDate:NOTE Own contribution must be
invested 5% for SC/ST/OBC/PHC/woman/ Ex-serviceman/ North East
Reason/Hill Boarder Area and 10% for General Total Project Cost
should not exceed 25 lakhs for Manufacturing unit and 10 lakhs for
service unit. Applicant will not be entitled for additional Margin
Money(Subsidy) in case of Own Contribution over and above the
prescribed limit. VIIIth pass for Manufacturing Unit above Rs.10
lakhs project cost and under Service Sector above Rs.5 lakhs
Application should be submitted complete in all respect along with
attested copies of the following documents:1. Certificate of
qualification-academic and technical (if project cost above 5 lakhs
under service industry or above 10 lakhs under Manufacturing
industry)2. Relevant Certificate for
SC/ST/OBC/Minority/Ex-Servicemen/PHC3. if Entrepreneur Development
programme(EDP) training undergone (at least for two weeks) then
submit photocopy of the certificate
PHOTOSelect Academic Qualification from the listSelect
sponsoring agency from the listSelect Gender from the listSelect
EDP Training taken from the list if EDP Training Taken enter Name
of the institution, training period and certificate issue date
etc.Select Social category of Applicant from the listSelect Unit
type from the list
Data SheetDATA INPUT SHEETLegal Status:LandBUILDING
DETAILSParticularsAreaRate/Sq.ftAmount in
Rs.0.000.000.0010.000.000.000.000.00MACHINERY
DETAILSParticularsQty.RateAmount in
Rs.0.000.000.000.000.000.000.000.000.000.000.000.00Total0.00d.
Preliminary & Pre-operative Cost :e. Furniture & Fixtures
:f. Contingency/Others/Miscellaneous :0.00Working Capital
:0.00Means of FinancingOwn Contribution :5%Bank Finance :95%Margin
Money (Govt. Subsidy) :25%DETAILS OF SALESParticulars of
ProductsRate/QantityAmount in Rs.UnitStone carving
products0.00Stone Artware & Decorative
Prod.0.000.000.000.000.000.00Total0.00RAW
MATERIALSParticularsUnitRate/UnitReqd. UnitAmount In
Rs.0.000.000.000.000.000.000.000.000.00Total0.00WAGESParticularsNo.
ofWages Per MonthAmount in Rs.WorkerTotal
Month120.000.000.000.000.000.000.00Total00.00SALARY
DETAILSParticularsNo. ofWages Per MonthAmount in Rs.StaffTotal
Month120.000.000.000.000.00Total00.00WORKING CAPITAL
ESTIMATEElement of Working CapitalNo. of DaysRaw materialsStock in
processFinished goodsReceivable byPOWER ESTIMATEPower
RequirementRepair and MaintananceRs.0.00Power and FuelRs.0.00Other
Overhead ExpensesRs.0.00Telephone ExpensesRs.0.00Stationery &
PostageRs.0.00Advertisement & PublicityRs.0.00Building
RentRs.1000.00Other Miscelleneous ExpenditureRs.0.00Rate of
InterestDepreciationOn Building5.00%On Machinery10.00%Pay back
period5Project Implementation Period212INTRODUCTIONABOUT THE
PROMOTEROffice Address:.District Industries Center000State:0Name
& Signature Inchargewith round seal
Enter Total Area inSq.ft / Sq.mtEnter actual Rent per MonthEnter
No. of QuarterEnter present rate of InterestEnter Estimated power
requirement in HP/KW/W
DPR_printDISTRICT INDUSTRIES CENTERPROJECT AT A GLANCE - TOP
SHEET1Name of the Entreprenuer02Constitution (legal Status)
:Individual3Father's/Spouce's Name04Unit Address
:00Taluk/Block:0District :0Pin:0State:0Phone :0E-Mail :05Product
and By Product06Cost of Project:Rs.07Means of FinanceTerm
LoanRs.0.0KVIC Margin MoneyRs.0.00Own CapitalRs.0.008Debt Service
Coverage Ratio:0.009Pay Back Period:5Years10Project Implementation
Period:12Months11Break Even Point:0.00%12Employment:013Power
Requirement:014Major Raw materials:,,15Estimated Annual Sales
Turnover:Rs.0.00DETAILED PROJECT REPORT1INTRODUCTION :02ABOUT THE
PROMOTER :03COST OF PROJECTA. Fixed Capital Investmenta. Land
:0Ownb. WorkshedArea Sq.ftRate in Rs.Amt. In
Rs.000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00Total0.000C.
MachineryQty.RateAmount in
Rs.000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00Total0.00d.
Preliminary & Pre-operative Cost :Rs.0.00e. Furniture &
Fixtures :Rs.0.00f. Contingency/Others/Miscellaneous :Rs.0.00Total
Capital Expenditure :Rs.0.00Working Capital :Rs.0.00Total Cost
Project :Rs.0.003.1Means of Financing :Own
Contribution5%Rs.0.00Bank Finance :95%Term LoanRs.0.00Working
CapitalRs.0.00TotalRs.0.00Margin Money (Govt. Subsidy) From
KVIC25%Rs.0.00Margin Money Subsidy received From KVIC will be kept
in term deposit as per norms ofPMEGP in the name of Beneficiary for
three years in the financing branch.3.2STATEMENT SHOWING THE
REPAYMENT OF TERM LOAN & WORKING CAPITAL :TERM LOANYearOpening
BalanceInstallmentClosing BalanceInterest
@0.00%1st00002nd00003rd00004th00005th00006th00007th00008th0000WORKING
CAPITALYearOpening BalanceInstallmentClosing BalanceInterest
@0.00%1st00002nd00003rd00004th00005th00006th00007th00008th00003.3STATEMENT
SHOWING THE DEPRECIATION ON FIXED
ASSETS:[email protected]%Particulars1st Year2nd Year3rd Year4th Year5th
YearOpening Balance00000Depreciation00000Closing
[email protected]%Opening
Balance00000Depreciation00000Closing Balance00000TOTAL
DEPRECIATIONWorkshed00000Machinery00000Total000004Schedule of Sales
Realization :4.1Details of SalesParticulars of ProductRate/No.
ofAmount in Rs.Pair/UnitPair/Unit0Stone carving
products0.0000.00Stone Artware & Decorative
Prod.0.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.00Total0.004.2Capacity
Utilization of SalesParticulars1st Year2nd Year3rd Year4th Year5th
YearCapacity Utilization70%80%90%90%90%Sales /
Receipts000005Rawmaterials :ParticularsUnitRate/unitReqd.UnitAmount
in
Rs.000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00000.0000.00Total0.005.1Wages
:ParticularsNo. ofWagesAmount in Rs.WorkerPer Month(Per
Annum)000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00Total00.005.2Repairs
and Maintenance :Rs.0.005.3Power and Fuel :Rs.0.005.4Other Overhead
Expenses :Rs.0.006Administrative Expenses
:6.1Salary000.000.00000.000.00000.000.0000.000.0000.000.00Total00.006.2Telephone
Expenses0.006.4Stationery & Postage0.006.5Advertisement &
Publicity0.006.6Workshed Rent12000.006.7Other Miscellaneous
Expenses0.00Total12000.007Capacity Utilization of Manufacturing
& Administrative Expenses :Particulars1st Year2nd Year3rd
Year4th Year5th YearCapacity
Utilization70%80%90%90%90%Manufacturing
ExpensesRawmaterials00000Wages00000Repairs &
Maintenance00000Power & Fuel00000Other Overhead
Expenses00000Administrative ExpensesSalary00000Postage Telephone
Expenses00000Stationery & Postage00000Advertisement &
Publicity00000Workshed Rent1200012000120001200012000Other
Miscellaneous
Expenses00000Total:12000120001200012000120008Assessment of Working
Capital :ParticularsAmount in Rs.Sale0.00Manufacturing ExpensesRaw
Material0.00Wages0.00Repair & Maintenance0.00Power &
Fuel0.00Other Overhead Expenses0.00Production
Cost0.00Administrative Cost12000.00Manufacturing
Cost12000.00Working Capital Estimate :Element of Working CapitalNo
of DaysBasisAmount in Rs.Raw materials0Material Cost0.00Stock in
process0Production Cost0.00Finished goods0Manufacturing
Cost0.00Receivable by0Manufacturing Cost0.00Total Working Capital
RequirementPer Cycle0.009Financial Analysis9.1Projected Profit
& Loss Account :Particulars0 Year1st Year2nd Year3rd Year4th
YearSales / Receipts00000000Manufacturing
ExpensesRawmaterials0000Wages0000Repairs & Maintenance0000Power
& Fuel0000Other Overhead Expenses0000Depreciation0000Production
Cost0000Administrative ExpensesSalary0000Postage Telephone
Expenses0000Stationery & Postage0000Advertisement &
Publicity0000Workshed Rent12000120001200012000Other Miscellaneous
Expenses0000Administrative Cost12000120001200012000Interest on Bank
credit @ 0%Term Loan0000Working Capital Loan0000Cost of
Sale12000120001200012000Net Profit Before
Tax-12000-12000-12000-12000Less Tax0.000.000.000.00Net
Profit-12000-12000-12000-120009.2CALCULATION OF DEBT SERVICE CREDIT
RATIO (D.S.C.R) :Particulars0 Year1st Year2nd Year3rd Year4th
YearNet Profit-12000-12000-12000-12000Add :Depreciation0000TOTAL -
A-12000-12000-12000-12000Payments :On Term Loan
:Interest0000Installment0000On Working CapitalInterest0000TOTAL -
B0000D.S.C.R = A/B0.000.000.000.00Average D.S.C.R9.3PROJECTED
BALANCE SHEET :Particulars0 Year1st Year2nd Year3rd Year4th
YearLIABILITIES :Promoters
Capital0000Profit-12000-12000-12000-12000Term Loan0000Working
Capital Loan0000Current Liabilities0000Sundry
Creditors0000-12000-12000-12000-12000ASSETS :Gross Fixed Assets
:0000Less : Depreciation0000Net Fixed Assets0000Preliminary &
Pre-Op. Expenses0000Current Assets0000Cash in
Bank/Hand-12000-12000-12000-12000Total-12000-12000-12000-120009.4CASH
FLOW STATEMENT :Particulars0 Year1st Year2nd Year3rd Year4th
YearNet Profit-12000-12000-12000-12000Add : Depreciation0000Term
Loan0000Working Capital Loan0000Promoters
Capital0000Total-12000-12000-12000-12000Total Fixed Capital
Invested0Repayment of Term Loan0000Repayment of WC Loan0000Current
Assets0000Total0000Opening
Balance0-12000-24000-36000Surplus-12000-12000-12000-12000Closing
Balance-12000-24000-36000-480009.5BREAK EVEN POINT AND RATIO
ANALYSIS :Particulars0 Year1st Year2nd Year3rd Year4th YearFixed
Cost12000120001200012000Variable Cost0000Total
Cost12000120001200012000Sales0000Contribution (Sales-VC)0000B.E.P
in %0.00%0.00%0.00%0.00%Break Even Sales in Rs.0000Break Even
Units0000Current Ratio0.000.000.000.00Net Profit
Ratio0.00%0.00%0.00%0.00%This Project Report has been prepared
based on the data furnished by the entrepreneur whose details are
given in the application.Place :0Date:31-Dec-99Prepared by
:.District Industries Center000State0Full Name :0e-Mail:0Ph.
No.:0Signature of the BeneficiaryFax:0Name & Signature Office
Inchargewith round seal
&L&G&L&"Tahoma,Regular"&8PMEGP Project
Report&RPage &P
Project_ReportPROJECT REPORT FOR0Affix
latestattestedPhotograph1Name of the
Entreprenuer01Individual2Constitution (legal Status)
:IndividualCo-Operative SocietyRegd. InstitutionS H
G's3Father's/Spouce's Name0Trust5Unit Address
:00Taluk/Block:0District :0Pin:0State:0Phone :0E-Mail :06Background
of the Proprietor/Partners/Directors :Furnished detailed
information in the DPR7Name of Business House/Group if any
:8Details Other Companies/Units in the group :Other Companies /
Units in the Group(Rs. in Lakhs)Name &
AddressBusinessEquityReservesLoansTurnover*P.B.T**P.A.Tof Company /
Unit* Profit Before Tax** Profit After Tax`8.1How the activity was
financed so far :( To be filled up in case of existining unit Only
)*Source of FundsSecurityRate ofRepayment perPresent O/sAmount of
DefaultInterestMonth( Rs. in '000 )(if any)8.2If the Unit is an
ancillary one, undertaking towhich it is catering and its address
:8.3Employment
:PresentProposed000000000000000000000000Total09Project Details for
Proposed New Unit :Copy of detailed project report is
enclosed.aExpansion / Mordenisation :bSetting up of New unit
:cActivity for proposed new unit :dProduct / Item proposed to
undertake :9.1Capacity (Furnish the details of Installed capacity
& production :(No. in Units/ Qty. in Kg./Volume in liter per
annum)Capacity is arrived at on the basis ofDays working onshift
basisProduct &Present InstalledMaximum Prod.Proposed
InstalledMaximum Prod.By-product if anyCapacityAchievedCapacity of
1st Yearenvisaged70.00%09.3State the manufacturing process in brief
:9.4Has the proposed process ever been tried in thecountry or newly
adopted? :9.5Technical Arrangements :9.6Describe arrangement for
Key Officialfor managing the proposed unit :Technical
ManpowerAdministrative ManpowerAccounting personnel9.7Particulars
of LandExistingProposedLocation of the Land :Area of Land :Status
of the Land :Nature of Land :Availability of Water :9.8Particulars
of BuildingExistingProposed(Enclose the plan & Estimation for
the proposed Building)AreaValue in Rs.StatusAreaValueStatusFactory
Building :Ancillary Building :Storage :Total :0.000.009.9Plant and
MachineryExisting (Value in Rs.)Proposed (Value in
Rs.)Indigenous0.00Imported(Enclose the plan layout of the existing
plant and machinery )9.10Rawmaterials / ComponentsReq. of Raw
material/Components/ChemicalsQty. in
Nos./Kgs./TonRate/Nos./Kgs/TonsValue in Rs.Total0.009.11Utilities
(Furnish details on requirement, availability, adequacy,
qualitative aspects etc..)Particulars of UtilitiesContracted
LoadConnected LoadFurther requirementin HP/KW/Win HP/KW/Win
HP/KW/WPowerWaterFuelOthers (Specify)9.12Environment Aspect of the
Project :9.13Requirement of Manpower for the Project :Particulars
of ManpowerTotal RequirementSalary/Wages per monthCost per
Annum000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00000.000.00Total00.009.14Schedule
of Implementation :B A R C H A R TActivitiesDate of
CommencementExpected Date of Completiona. Acquisition of Landb.
Development of Landc. Civil Works for Factory / BuildingMachinery /
Foundation etc..d. Plant & MachineryImportedIndigenouse.
Arrangement for powerf. Arrangement for waterg. Errection of
equipmenth. CommissioningI. Procurement of Raw
materials/Chemicalsj. Trail Runsk. Commercial Production10Cost of
Project :(Rs. in '000)Sr.No.ParticularsAlready IncurredTo be
IncurredTotal CostALand including Development0.000.00BBuilding
& Other Civil Works0.000.00CPlant and Machinery1.
Indigenous0.000.002. Imported0.00DFurniture &
Fixture0.000.00ETesting equipment0.00FMiscellaneous Fixed
Assets0.00GErrection & Installation
Charges0.00HContingency0.000.00IPreliminary & Pre-Op.
Cost0.000.00JProvision for1. Buildings0.002. Plant &
Machinery0.003. Other Fixed Assets0.00KWorking Capital for
one0.000.00Operating CycleLTotal0.000.000.0011Means of Financing
:(Rs. in '000)Sr.No.ParticularsAmount alreadyAmount
ProposedTotalRaisedto be RaisedAEquity / Promoters
Contribution0.000.00BReserves0.00CTerm Loans0.000.00DUnsecured
Loans and Deposits0.00(Indicate sources, roi, repayment
etc)EDeferred Payment0.00Arrangements including Suppliers
creditFSubsidyCentral Government0.000.00State Government0.00GSeed
Capital0.00HInternal Cash Accruals0.00IOther Sources
(Specify)0.00JTotal0.000.000.0011.1In case internal accruals are
taken assource of finance explain the basis ofestimation of
internal accruals :11.2Indicate source from which
expenditurealready incurred has been financed :11.3% of Promoters
contribution of the :total cost of project12Marketing & Selling
Arrangements of the Product :13Projected Profitability :Projected
Profitability Statement given in theDetailed Project
Report.14Projected Cash flow Statement :Projected Cash flow
Statement given in theDetailed Project Report.% of Cash Sales in
Total Sales :Period in which payment is receivedDaysin respect of
Credit SalesAverage Credit Available on Purchase :Days15Working
Capital Required for the :Rs.0.00anticipated turnover16Repayment
Programme :Detailed Repayment programme for Term loan andWorking
capital loan have been given in the DPR.17Details of Securities to
be Offered :17.1Primary ( Furnish details for term loan and :
:working capital loan separately )17.2Collateral, if any (Details)
:17.3Details of Guarantor(s) :1. Name :2. Residential Address :3.
Occupation :4. Details of movable & immovableproperties owned
by him /her/otherfamily members5 Details of any other similar
guarantees:if any, given to other institutions18Government Consents
:(Give deatails of various licenses / consents required to be
obtained from various authorities for the proposed
project)19DECLARATIONI / We hereby declare that the information
given herein before and the statements and other papers enclosed
are, to the best of our knowledge and belief, true and correct in
all particularsDate :0Signature of the BorrowerPlace :0Name &
Designation (In case of Regd. Inst.)
Enter name of product hereIf the Proprietor / Institution runs
any other existing activity which may be clearly indicated here.If
any Company & Unit exists in the name of Individual / Inst. the
details as per table may be furnishedEnter type of work
undertakingEnter Name and Detailed Address of the undertaking to
which the unit working as ancillary.Enter the present strength of
manpower in the existing firm other than REGPEnter any one of the
following appropriate for the proposed
activity.ManufacturingProcessingServicingEnter no. of working days
of the unit per annumEnter no. of shift per daySingleTwoThreeEnter
name of main Product and by-product if any seperatelyEnter
installed capacity of existing unit. Otherwise enter NA.Enter the
value of maximum production achieved under existing unit, otherwise
enter NAEnter the value of proposed production under new unit as
per project reportEnter installed capacity of proposed new unit as
estimated in the project reportBrief here the process of
manufacturing of the proposed product. If more space required
insert more rows and merge with the existing one.Indicate briefly
onSpecific processing technique of the
product.Suitability/adoptability of the process at the
location.Indicate briefly onSatisfactory arrangement for
Know-howCollaboration involvement if any and financial
participation.Details of consultants if any.Give brief on the
source, experience, cost to meetout the proposed tech.
Manpower.Give brief on the source, experience, cost to meetout the
proposed Admn. Manpower.Give brief on the source, experience, cost
to meet out the proposed Accounting personnel.Indicate the
Village/Town/ Dist./State where the land is located.Indicate the
total area of the land in Sq.mt / Sq.ft.Enter hereLeased
orOwnedEnter hereAgriculturalNon-AgriculturalIndicate here,
availability and suitability of water for the proposed
project.Indicate the Village/Town/ Dist./State of the proposed land
if it is not with the existing one.Indicate the total area of the
proposed land in Sq.mt / Sq.ft.Enter hereLeased orOwnedEnter
hereAgriculturalNon-AgriculturalIndicate here, availability and
suitability of water for the proposed project.Indicate the status
of buildingLeasedOwnedIndicate the status of
buildingLeasedOwnedIndicate the status of
buildingLeasedOwnedIndicate the status of
buildingLeasedOwnedIndicate the status of
buildingLeasedOwnedIndicate the status of buildingLeasedOwnedList
the required Raw materials / Components/Chemicals required for the
projectsEnter the Quantity in terms of Nos./Kgs/TonsEnter the rate
per unitEnter Total ValueEnter total requirement of power in
HP/KW/WEnter connected power if any in HP/KW/WEnter further power
connection if any in HP/KW/WBrief here nature of atmospheric, soil
and water pollution likely to be created by the proposed project
and measures proposed to control the same. Indicate the clearance
of pollution control board.Enter the Nature of ManpowerEnter 'Yes'
or 'No'WarningDo not enter any data here!Enter Name of Guarantor
hereEnter hereFull address of the guaranterEnter hereOccupationList
hereDetails of Movable / Immovable property owned by
him/her/themEnter hereThe property details and bankEnter Brief
notes on1. The Products and Uses2. Scope for market & Special
features if any3. Competition 4. Potential for export5. Sales
arrangement made
DPR_FRONTProject Report on0Prepared By:.District Industries
Center000State:0e-Mail:Ph. No.:Fax:
&L&G