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Industry Name

(max 250 characters)

Category:*

Please select the Category

Industry Type:

Industry Status: *

(select current status)

Approximate date of proposed Establishment of HCF/CBWTF :

Expected date of commencement of date of Operation :

Industry Registration/HCE License No.:

(registration.Date ) (reg.address max 250 char )

Capital Investment of Plant & Machinery:*

(in lakhs)

Capital Investment:

(in lakhs)

Address/Place:*

(enter industry address)

Plot No./Mauza NO./ Revenue SurveyNo:*

(enter plot number)

Khata no.:*

(enter khata number)

Khesra no.:*

(enter khesra number)

Post Office:

(enter Post Office of industry locality)

Village/City:

(enter village/city of industry locality)

District:*

(select district)

Block:*

(enter industry Block)

Area:*

Pin :

(enter PIN of industry address)

Phone Number:*

(STD Code - Number)

Fax No. With Code :

(STD Code - Number)

E-Mail Address :

e.g. info@abc.com

Shifts in Industry :

Whether industry premises declared as prohibited Area:

Working Seasons per year :

From To

Expected Date of Production :

No. of workers attending factory per day :

No. of persons residing in premises:

Surrounding of Site (within 500 meters):

Name :	Description:	Distance in Meters:
Legacy

Occupier Name:*	(maximum 50 chars)
Designation:* :	(designation of occupant)
Address :	(address, max 100 chars)
Village/City:*	(village/city of address)
District:*	(write district)
Block:*	(select Block)
Pin:	(PIN of occupant address)
Phone No. With Code:	(STD Code - Number)
Fax No. With Code :	(STD Code - Number)
Mobile No:	(occupant mobile no)
E-Mail Address:	e.g. info@abc.com
ID Proof Details :*	(ID Proof Name) (ID Proof Number) (Attach ID Proof)
Status of Applicant:
Name, Address and Telephone of the Chairman/Managing Director/Managing Partner/Owner/Board of Director List (Full Time or Part Time) Other Kinds or Office Bearers are to be Furnished with their Period of Tenures in the Respective Office : Example:::- Name:-Munish Designation:-Chairman Address:-Jabalpur Period Of Tenures:-25/01/2005 To 21/06/2009 Telephone:-3234123
Hint Question:*	(select question)
Your Answer:*	(answer of hint question)
Click to generate Password:*	Click here to generate password
Generated Password:*	This is one time password
Document, if any:	(.pdf,.jpg,.jpeg,.gif max of 2MB in size)
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