- The Central Government may withdraw the approval given to an undertaking under this Scheme if the undertaking fails to comply with any of the conditions listed in paragraph 4 and 5 of this Scheme:Provided that before withdrawal of approval, the undertaking shall be given an opportunity of being heard by the Central Government.FORM IPS-I(See Paragraph 3 of the Scheme)Application For Consideration Under The Industrial Park Scheme,2008I.I Name and address of the Undertaking (Indian or International) in full (Block Letters):(a)Registered Address:Name of the Undertaking_____________________________Name of the contact person____________________________Postal Address______________________________________Pin Code____________________________Tel. No._____________________________ Telex_____________Fax No._____________________________Cable______________E-mail_____________________________________(b)Address for correspondence (if different from (a) above):Name of the Undertaking_____________________________Name of the contact person____________________________Postal Address______________________________________Pin Code____________________________Tel. No._____________________________ Telex_____________Fax No._____________________________Cable______________E-mail_____________________________________II. Registrar of Companies Registration No._______________(If registered)III. Status of Undertaking(1)Central Government Undertaking(2)State Government Undertaking(3)State Industrial Government Corporation(4)Cooperative Undertaking(5)Joint Sector Undertaking(6)Private Sector Undertaking(7)Individual Promoter(8)Foreign or Non Resident Indian or OCB Company(9)Foreign or Non Resident Indian Individual(10)Partnership Firm(11)Registered Societies(12)Any other (please specify)IV. Equity structure in the undertaking:-(a)Total Equity of the undertaking (in Rs. Crores)_________________(b)Equity structure (Give brief details of entities holding the equity in the undertaking)S. No. Details of entity Percentage of equity held(a)Public holding(b)Private holdingTotal(c)Details of entities holding more than 20 per cent. of equity in the undertaking:-Name_______________________________Post address_________________________Pin Code_____________________________Tel. No.______________________________Fax No.______________________________Email________________________________Permanent Account No._________________Percentage of proposed equity holding___________________2.1Proposed location of the Industrial ParkAddress of location of Industrial Park (Indicate complete address):-Plot No._____________________________Name of the Building (if any)__________________Survey Number_____________________________Village____________________________________Taluka or Tehsil_______________________________District_______________________________________State________________________________________Pin Code______________________________________2.2Details of the proposed Industrial Park(a)Total proposed constructed floor area (in square metres)____________(b)Total allocable area (in square metres)__________________(c)Proposed allocable area for industrial use (in square metres)_______(d)Proposed allocable area for commercial use (in square metres)________(e)Allocable area earmarked for industrial use (percentage)________(f)Allocable area earmarked for commercial use(percentage)________2.3Details of manufacturing activities to be undertaken by industrial units:2.4(a)Minimum number of industrial units to be located______________(b)Employment likely to be generated -Details Direct Indirect Totali) Skilledii) Semi-skillediii) Unskillediv) Total2.5(a)Proposed investment (Amount in rupees in lakhs)(b)Investment on Infrastructure Development (Amount in rupees in lakhs)(c)Percentage of (b) to (a)(d)Complete details of infrastructure facilities proposed to be provided in the industrial parkS. No. Item of infrastructure Investment (Rs. In lakhs)2.6Total foreign equity existing (Amount in rupees in lakhs) _________2.7Expected or Actual Date of Commencement of Industrial Park _______3.1Whether the industrial park is located or developed as a separate identifiable area3.2Whether the industrial park is independent of other projects or is an extension or part of any other project3.3The nature of title the undertaking holds on the land on which the project is situated3.4Whether the project is developed under any agreement and if yes, the address ______________of other parties (other than applicant)______________to such an agreement ______________3.5Whether the applicant undertaking has powers to allow industrial and commercial units as proposed in the application to operate from the industrial park mentioned in the application.(If there is any type of restrictions in thisregard please indicate the same)3.6Whether all the criteria as mentioned in para 4 of the Industrial Park Scheme, 2008 are met or not:(a)The date of commencement of the Industrial Park should be on or after the 1st day of April 2006 and not later than the 31st of March 2009;(b)The area allocated or to be allocated to industrial units shall not be less than ninety per cent of the allocable area;(c)There shall be a minimum of thirty industrial units located in a industrial park;(d)For the purpose of computing the minimum number of industrial units; all units of a person and his associated enterprises will be treated as a single unit.(e)The minimum constructed floor area shall not be less than 50,000 square meters;(f)No industrial unit, along with the units of an associated enterprise, shall occupy more than twenty five per cent of the allocable area;(g)The industrial park should be owned by only one undertaking; and(h)Industrial units shall undertake only manufacturing activity as defined in Section D of the National Classification, 2004 Code issued by the Central Statistical Organisation, Department of Statistics.DeclarationI/We hereby undertake to continue to operate the Industrial Park during the period in which the benefits under sub-section 4(iii) of the section 80-IA of the Income-tax Act, 1961 are to be availed.I/We hereby certify that the above statements are true and correct to the best of my/our knowledge and belief.(Signature of Applicant)(Name in Block Letters)(Designation of the Signatory)Place:_____________Date:______________List of Enclosures
