1	Registration Number: (As provided by DH&T & GOK)
2	Name of Unit:
3	Registered Address of Company:
4	Address of the Unit	District: Select districtBAGALKOTEBENGALURU URBANBENGALURU RURALBELAGAVIBALLARIBIDARVIJAYAPURACHAMARAJANAGARChickballapuraCHIKKAMAGALURUCHITRADURGAMANGALURUDAVANAGEREDHARWADGADAGKALABURGIHASSANHAVERIMADIKERIKOLARKOPPALMANDYAMYSURURAICHURRAMANAGARSHIVAMOGGA TUMAKURUUDUPIUTTAR KANNADAYADGIRITestDSTKSTIDCL Taluk: Select City/Town : Postal Pin Code:
5	Size of the Unit	Micro Small Medium Large Mega
6	Zone (Annexure 10)	SelectNew UnitExpansionModernizationDiversification Zone1 Zone2 Zone3 Zone4
7	Registration(As mentioned in Entrepreneur Memorandum EM)	Number Registration Date
8	GST Registration	Number Registration Date
9	Nature of industry:	SelectSpinning(Thrust Sectors)Integrated Unit(Thrust Sectors)Weaving(Thrust Sectors)Processing(Thrust Sectors)Technical Textile(Thrust Sectors)GarmentsOthers Please specify:
10	Products Manufactured:
11	Constitution of Industry:	SelectProprietaryPartnershipCompanyOthers Please specify:
12	Category of the Entrepreneur:	SelectSCSTWomenEx-ServicemenPersonwith disabilitiesMinorityGeneral
13	Is it New Industry or Existing:	SelectNewUndertakenExpansionModernizationDiversification
14	Project Cost (INR in Number)	Land: Building: Plant & Machinery : Others: Total:
15	Date of Commercial Production :
16	Name of the Term loan lending Institution / Bank / FI:	Date of Loan Sanction: Amount of Loan Sanctioned: (INR in lakhs)
17	Employment Provided in the New Unit:	SelectAdditional Employment CreatedForm of Declaration Regarding Employment of “Local Persons” (Annexure 9)
18	Contact Details:	Name : Phone : Email Address :
19	Bank Account Details:	Name of the Holder Name of Bank: Branch Name Account Number IFSC Code Please Tick the Incentive You would like to Claim (1) Capital Subsidy – Form 1: (2) Interest Subsidy – Form 2 : (3)Stamp Duty Exemption and Concessional Registration Charges- Form 3: (4) Reimbursement of Power Subsidy- Form 4: (5)Wage Subsidy – Form 5 (6) ESI/EPF- Form 6: (7) EPT- Form 7:
20	Attachments	Note 1: Furnish the following documents (as applicable) (a) Copy of SLPIC / HLEC Approval if any (b) Copy of the Application submitted to KUM / KIADB, if any (c) Copy of Detailed Project Report submitted in the prescribed format (d) Copy of Statutory Approval received, if any (e) Copy of Entrepreneur Memorandum
		Note 2: Furnish the following documents for existing units undertaking Expansion / Diversification / Modernization / Technology Up-Gradation (a) Copy of additional power sanctions letter / change in consolidated power sanction and new meter installation report, if any. (b) Proof of power consumption in the preceding 6 months prior to expansion / diversification / modernization. (c) Average 6 months cost of power consumption during the immediate 6 months after expansion / diversification / modernization supported by bills, receipts, vouchers etc., (d) Copy of rent / lease deed as the case may be in case of rental / leased buildings.

Form 1: Credit Linked Capital Subsidy
1	Name of Unit:
2	Address of the Unit :
3	Zone (Annexure 10)	SelectNew UnitExpansionModernizationDiversification Zone1 Zone2 Zone3 Zone4
4	Investment on Proposed Component (in INR) :
5	Investment Bracket	Enterprise Textile Garment Micro INR 25 lakhs INR 25 lakhs Small INR 25 lakhs up to INR 5 crores INR 25 lakhs up to INR 5 crores Medium INR 5 crores up to INR 10 crores INR 5 crores up to INR 10 crores Large Up to INR 300 Crores Up to INR 200 Crores
6	Additional Subsidy:	SelectSCSTWomenEx-ServicemenPersonwith disabilitiesMinorityGeneral
7	Special Credit Linked Subsidy:	SelectSpinningIntegrated UnitWeavingProcessingTechnical TextileGarmentsOthers Please specify:
8	Attachments	Note: Furnish the following documents: 1. Common Application Form-A 2. Statements of the Fixed Assets in the prescribed format certified by the Unit (Annexure 2) Download the Annexure 2 3. Investment Certificate in the prescribed form issued by the FI / Bank (Annexure 3) Download the Annexure 3 4. Government approved/ registered Engineers / Architect’s Certificate in the prescribed format regarding investment made on Construction of Building (as per current year PWD S.R. rates)(Annexure 5) Download the Annexure 5 5. Investment Certificate in the prescribed format issued by the Chartered Accountant (Annexure 6) Download the Annexure 6 6. Certificate from Bank / FI stating Loan Details in the prescribed format (Annexure 7) Download the Annexure 7 7. Form of Declaration regarding employment of Local Persons (Annexure 9) Download the Annexure 9 8. Investigation Report in the prescribed format (Annexure A) 9. Copy of Caste certificates in respect of SC/ST and appropriate certificate/ documents in respect ofphysically challenged/ Ex-servicemen entrepreneurs from the Competent Authority of Government of Karnataka 10. Detailed Project Report 11. First Sale Invoice 12. NOC from Pollution Control Board 13. Land Purchase Documents Registration Copy Katha Extract Encumbrance Certificate 14. Land Conversion Copy 15. Copy of Rent & Lease Agreement for the period of 10 years 16. Power Sanction Letter 17. General License from Competent Authority 18. MSME Certificate (Unit registered under Textile Activity) 19. Copies of Receipts / Bills / Vouchers etc. in respect of Payments made towards Investment 20. GST Registration Certificate 21. NOC from District Industry Centre (DIC) for not claiming subsidy under Industrial Policy 22. NOC from Factories and Boilers (if applicable)

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