Application ID: (For office use)

APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTERS

EMPLOYMENT GENERATION PROGRAMME (PMEGP)
12 Name of the project / business activity proposed :

13 Amount of loan required (in Rs.)

Capital Expenditure Loan
Working
Building Type Workshed Machinery/ Pre
Capital /
Building Equipment/ Operative
Cash Credit Total
etc. Furniture Cost
Limit
Rented 125000 60000 15000 25000 225000
Details of earlier or current Loan/Grant and subsidy availed from
14 Central/State Govt. Scheme/ or any other Similar Scheme.
Activity of the Project with Address Amount Year of Sanction

I 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 project

Place:
Date: Signature of the Applicant

For Official Use only: (Rejected / to be placed before District Task force Committee)
Reason (if Rejected):

Place: Signature, Name & Designation of Officer

Date:
 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/PHC
3. if Entrepreneur Development programme(EDP) training undergone (at least for two weeks)
then submit photocopy of the certificate
 DATA INPUT SHEET

Preference for sponsoring agency of the project : (mark √ )

Unit Location (As per revenue record) : (mark √ )
KVIC KVIB DIC √ COIR Board
1.1 Name of the Applicant/Institution
SUNIL DEKA
1.2
GIRINDRA DEKA
2 Gender Male √ Female Transgender
3 Address of the Proposed location of Unit: Rural √ Urban

5 Whether the applicant belongs to (mark √) ###

Ex- Service Aspirational
SC ST OBC PHC Minority Hill Border Area General
man Districts
√

Whether the project Manufacturing

6
(mark √) Unit
Service Unit √
8 Name of the project / business activity proposed :
DIARY FIRM

Legal Status:

Land 8000 ###

BUILDING DETAILS
Particulars Area Rate/Sq.ft Amount in Rs.
Land(self owned) 8000 0.00 0.00
COW SHED (BY BRICK, BAMBOO,SAND,STONE ET 125000.00
0.00
0.00
0.00
0.00
0.00

MACHINERY DETAILS
Particulars Qty. Rate Amount in Rs.
EQUIPMENT 1 30000.00 30000.00
Electification 1 20000.00 20000.00 Male
0.00
0.00 Trans
0.00 ###
0.00 KVIC
0.00 KVIB
0.00 DIC
0.00
0.00
0.00 Rural
0.00
0.00
Total 50000.00 No

d. Preliminary & Pre-operative Cost : 10000.00 SC

e. Furniture & Fixtures : 10000.00

f. Contingency/Others/Miscellaneous 5000.00

Working Capital : 25000.00

Manu
 Means of Financing Unde

Own Contribution : 5%
Bank Finance : 95%
Margin Money (Govt. Subsidy) : 35%

Own
Rate/ Qantity Amount in Rs.
Particulars of Products
Unit
MILK 50.00 2250 45000.00
CALF 20000.00 2 40000.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 85000.00

RAW MATERIALS
Particulars Unit Rate/Unit Reqd. Unit Amount In Rs.
COW FEED 18000 20.00 18000 360000.00

Total 360000.00

WAGES
No. of Wages Per Month Amount in Rs.
Particulars
Worker Total Month 12
LABOUR 2 6000.00 72000.00
Total 72000.00

SALARY DETAILS
No. of Wages Per Month Amount in Rs.
Particulars
Staff Total Month 12
MANAGER SELF 0.00
0.00
0.00
0.00
0.00
Total 0 0.00

WORKING CAPITAL ESTIMATE

Element of Working Capital No. of Days

Stock in process 2

Finished goods 1

Receivable by 7

POWER ESTIMATE
Power Requirement 2 KW

Repair and Maintanance Rs. 5000.00

Power and Fuel Rs. 20000.00

Other Overhead Expenses Rs. 1000.00

Telephone Expenses Rs. 0.00

Stationery & Postage Rs. 1000.00

Advertisement & Publicity Rs. 0.00

Building Rent Rs. 0.00

Other Miscelleneous Expenditure Rs. 5000.00

Rate of Interest 12.00%

Depreciation
On Building 5.00%
On Machinery 10.00%

INTRODUCTION
ABOUT THE BENEFICIARY
 PROJECT AT A GLANCE - TOP SHEET
1 Name of the Beneficiary SUNIL DEKA

2 Constitution (legal Status) Individual

3 Father's/Spouce's Name GIRINDRA DEKA

4 Unit Address : VILLAGE PIPLA, P.O. NITYANANDA

0
Taluk/Block: BAJALI
District : BARPETA
Pin: 781329 State: ASSAM
E-Mail : 0
Mobile 8011918363
5 Product and By Product

6 Cost of Project : Rs. 5,00,000

Name of the project / business
DIARY FIRM
activity proposed :
7 Means of Finance
Term Loan Rs. 4,75,000.00
KVIC Margin Money Rs. 1,75,000.00
Own Capital Rs. 25000.00

8 Debt Service :
Coverage Ratio

9 Pay Back Period : 5 Years

10 Project : 3 Months
Implementation
Period

11 Break Even Point : 36.50%

12 Employment : 5

13 Power Requirement : 2 KW

14 Major Raw materials : COW FEED,,

15 Estimated Annual : Rs. 13500000.00

Sales Turnover

PMEGP Project Report Page 9

 DETAILED PROJECT REPORT
1 INTRODUCTION :

2 ABOUT THE BENEFICIARY :

3 COST OF PROJECT
A. Fixed Capital Investment
a. Land : 8000 Own

b. Workshed Area Sq.ft Rate in Rs. Amt. In Rs.

Land(self owned) 8000 0.00 0.00
COW SHED (BY BRICK, BAMBOO,SAND,STONE ET 0 0.00 125000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 125000.00
#REF!
C. Machinery Qty. Rate Amount in Rs.
EQUIPMENT 1 30000.00 30000.00
Electification 1 20000.00 20000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 50000.00

PMEGP Project Report Page 10

 d. Preliminary & Pre-operative Cost : Rs. 10000.00

e. Furniture & Fixtures : Rs. 10000.00

f. Contingency/Others/Miscellaneous Rs. 5000.00

Total Capital Expenditure : Rs. 200000.00

Working Capital : Rs. 15427.00

Total Cost Project : Rs. 215427.00

3.1 Means of Financing :

Own Contribution 5% Rs. 10771.00

Bank Finance : 95%

Term Loan Rs. 190000.00
Working Capital Rs. 14656.00

Total Rs. 204656.00

Margin Money (Govt. Subsidy) From KVIC 35% Rs. 75399.00

Margin Money Subsidy received From KVIC will be kept in term deposit as per norms of
PMEGP in the name of Beneficiary for three years in the financing branch.

3.2 STATEMENT SHOWING THE REPAYMENT OF TERM LOAN & WORKING CAPITAL :
TERM LOAN

Interest @
Year Opening Balance Installment Closing Balance
12.00%
1st 190000 9500 180500 22800
2nd 180500 38000 142500 21660
3rd 142500 38000 104500 17100
4th 104500 38000 66500 12540
5th 66500 38000 28500 7980
6th 28500 38000 0 3420
7th 0 0 0 0
8th 0 0 0 0

WORKING CAPITAL

Interest @
Year Opening Balance Installment Closing Balance
12.00%
1st 14656 733 13923 1759
2nd 13923 2931 10992 1671
3rd 10992 2931 8061 1319
4th 8061 2931 5130 967
5th 5130 2931 2198 616
6th 2198 2931 0 264
7th 0 0 0 0
8th 0 0 0 0

PMEGP Project Report Page 11

3.3 STATEMENT SHOWING THE DEPRECIATION ON FIXED ASSETS:
WORKSHED @ 5.00%
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Opening Balance 125000 118750 112813 107172 101813
Depreciation 6250 5938 5641 5359 5091
Closing Balance 118750 112813 107172 101813 96723
MACHINERY @ 10.00%
Opening Balance 50000 45000 40500 36450 32805
Depreciation 5000 4500 4050 3645 3281
Closing Balance 45000 40500 36450 32805 29525
TOTAL DEPRECIATION
Workshed 6250 5938 5641 5359 5091
Machinery 5000 4500 4050 3645 3281
Total 11250 10438 9691 9004 8371

4 Schedule of Sales Realization :

4.1 Details of Sales
Rate/ No. of Amount in Rs.
Particulars of Product Pair/Unit Pair/Unit
0
MILK 50.00 2250 112500.00
CALF 20000.00 2 40000.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
Total 152500.00

4.2 Capacity Utilization of Sales

Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year

Capacity Utilization 70% 80% 90% 90% 90%

Sales / Receipts 106750 122000 137250 137250 137250

5 Rawmaterials :
Particulars Unit Rate/unit Reqd.Unit Amount in Rs.
COW FEED 18000 20.00 18000 360000.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
Total 360000.00
5.1 Wages :
No. of Wages Amount in Rs.
Particulars Worker Per Month (Per Annum)
LABOUR 2 6000.00 72000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 2 72000.00

PMEGP Project Report Page 12

5.2 Repairs and Maintenance : Rs. 5000.00

PMEGP Project Report Page 13

5.3 Power and Fuel : Rs. 20000.00

5.4 Other Overhead Expenses : Rs. 1000.00

6 Administrative Expenses :
6.1 Salary
MANAGER SELF 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0.00 0.00
0 0.00 0.00
Total 0 0.00

6.2 Telephone Expenses 0.00

6.4 Stationery & Postage 1000.00

6.5 Advertisement & Publicity 0.00

6.6 Workshed Rent 0.00

6.7 Other Miscellaneous Expenses 5000.00

Total 6000.00
7 Capacity Utilization of Manufacturing & Administrative Expenses :
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Capacity Utilization 70% 80% 90% 90% 90%
Manufacturing Expenses
Raw materials 252000 288000 324000 324000 324000
Wages 50400 57600 64800 64800 64800
Repairs & Maintenance 3500 4000 4500 4500 4500
Power & Fuel 14000 16000 18000 18000 18000
Other Overhead Expenses 700 800 900 900 900
Administrative Expenses
Salary 0 0 0 0 0
Postage Telephone Expenses 0 0 0 0 0
Stationery & Postage 700 800 900 900 900
Advertisement & Publicity 0 0 0 0 0
Workshed Rent 0 0 0 0 0
Other Miscellaneous Expenses 3500 4000 4500 4500 4500
Total: 324800 371200 417600 417600 417600
8 Assessment of Working Capital :
Particulars Amount in Rs.
Sale 152500.00

Manufacturing Expenses
Raw Material 360000.00
Wages 72000.00
Repair & Maintenance 5000.00
Power & Fuel 20000.00
Other Overhead Expenses 1000.00

Production Cost 458000.00

Administrative Cost 6000.00
Manufacturing Cost 464000.00

PMEGP Project Report Page 14

 Working Capital Estimate :
Element of Working Capital No of Days Basis Amount in Rs.
0 0 Material Cost 0.00

Stock in process 2 Production Cost 3053.00

Finished goods 1 Manufacturing Cost 1547.00

Receivable by 7 Manufacturing Cost 10827.00

Total Working Capital Requirement Per Cycle 15427.00

9 Financial Analysis
9.1 Projected Profit & Loss Account :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Sales / Receipts 106750 122000 137250 137250
106750 122000 137250 137250
Manufacturing Expenses
Raw materials 252000 288000 324000 324000
Wages 50400 57600 64800 64800
Repairs & Maintenance 3500 4000 4500 4500
Power & Fuel 14000 16000 18000 18000
Other Overhead Expenses 700 800 900 900
Depreciation 11250 10438 9691 9004
Production Cost 331850 376838 421891 421204
Administrative Expenses
Salary 0 0 0 0
Postage Telephone Expenses 0 0 0 0
Stationery & Postage 700 800 900 900
Advertisement & Publicity 0 0 0 0
Workshed Rent 0 0 0 0
Other Miscellaneous Expenses 3500 4000 4500 4500
Administrative Cost 4200 4800 5400 5400
Interest on Bank credit @ 12%
Term Loan 22800 21660 17100 12540
Working Capital Loan 1759 1671 1319 967
Cost of Sale 360609 404968 445710 440111
Net Profit Before Tax -253859 -282968 -308460 -302861
Less Tax 0.00 0.00 0.00 0.00
Net Profit -253859 -282968 -308460 -302861

9.2 CALCULATION OF DEBT SERVICE CREDIT RATIO (D.S.C.R) :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit -253859 -282968 -308460 -302861
Add :
Depreciation 11250 10438 9691 9004
TOTAL - A -242609 -272531 -298769 -293857
Payments :
On Term Loan :
Interest 22800 21660 17100 12540
Installment 9500 38000 38000 38000
On Working Capital
Interest 1759 1671 1319 967
TOTAL - B 34059 61331 56419 51507
D.S.C.R = A/B
-7.12 -4.44 -5.30 -5.71
Average D.S.C.R

PMEGP Project Report Page 15

9.3 PROJECTED BALANCE SHEET :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
LIABILITIES :
Beneficiary's Capital 10771 10771 10771 10771
Profit -253859 -282968 -308460 -302861
Term Loan 190000 180500 142500 104500
Working Capital Loan 14656 13923 10992 8061
Current Liabilities 0 0 0 0
Sundry Creditors 0 0 0 0
-38432 -77774 -144197 -179529
ASSETS :
Gross Fixed Assets : 185000 173750 163313 153622
Less : Depreciation 11250 10438 9691 9004
Net Fixed Assets 173750 163313 153622 144618
Preliminary & Pre-Op. Expenses 10000 7500 5625 4219
Current Assets 14656 13923 10992 8061
Cash in Bank/Hand -226838 -255010 -308811 -332208
Total -38432 -77774 -144197 -179529

9.4 CASH FLOW STATEMENT :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit -253859 -282968 -308460 -302861
Add : Depreciation 11250 10438 9691 9004
Term Loan 190000 180500 142500 104500
Working Capital Loan 14656 13923 10992 8061
Beneficiary's Capital 10771 0 0 0
Total -27182 -78108 -145277 -181296

Total Fixed Capital Invested 200000

Repayment of Term Loan 9500 38000 38000 38000

Repayment of WC Loan 733 2931 2931 2931
Current Assets 14656 13923 10992 8061
Total 24889 54854 51923 48992

Opening Balance 0 -52071 -185033 -382233

Surplus -52071 -132962 -197200 -230288
Closing Balance -52071 -185033 -382233 -612521

9.5 BREAK EVEN POINT AND RATIO ANALYSIS :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Fixed Cost 38250 36898 32191 26944
Variable Cost 333609 378508 423210 422171
Total Cost 371859 415406 455400 449114

Sales 106750 122000 137250 137250

Contribution (Sales-VC) -226859 -256508 -285960 -284921

B.E.P in % -16.86% -14.38% -11.26% -9.46%

Break Even Sales in Rs. -17999 -17549 -15450 -12979

Break Even Units -360 -351 -309 -260

Current Ratio 0.42 0.22 0.19 0.15

PMEGP Project Report Page 16

 Net Profit Ratio -237.81% -231.94% -224.74% -220.66%

PMEGP Project Report Page 17

 This Project Report has been prepared based on the data furnished by the beneficiary whose details are
given in the application.
Place :
Date:
Prepared by :
Full Name : SUNIL DEKA

Signature of the Beneficiary

PMEGP Project Report Page 18

LED PROJECT REPORT

PMEGP Project Report Page 19

 1.00

PMEGP Project Report Page 20

PMEGP Project Report Page 21
PMEGP Project Report Page 22
 PROJECT REPORT FOR

Affix latest
attested
Photograph

1 Name of the Beneficiary SUNIL DEKA

1
2 Constitution (legal Status) Individual

3 Father's/Spouce's Name #REF!

5 Unit Address : 0
0
Taluk/Block: 0
District : 0
Pin: 0 State: #REF!
Phone #REF!
E-Mail #REF!

6 Background of the Proprietor/Partners/Directors : Furnished detailed information in the DPR

7 Name of Business House/Group if any :

8 Details Other Companies/Units in the group :

Other Companies / Units in the Group (Rs. in Lakhs)
Name & Address Business Equity Reserves Loans Turnover *P.B.T **P.A.T
of Company / Unit

* Profit Before Tax ** Profit After Tax

`

8.1 How the activity was financed so far : ( To be filled up in case of existining unit Only )
*Source of Funds Security Rate of Repayment per Present O/s Amount of Default
Interest Month ( Rs. in '000 ) (if any)

8.2 If the Unit is an ancillary one, undertaking to

which it is catering and its address :
8.3 Employment : Present Proposed
LABOUR 2
0 0
0 0
0 0
0 0
0 0
0 0
MANAGER SELF 0
0 0
0 0
0 0
0 0
Total 2

9 Project Details for Proposed New Unit : Copy of detailed project report is enclosed.
a Expansion / Mordenisation :

b Setting up of New unit :

c Activity for proposed new unit :

d Product / Item proposed to undertake :

9.1 Capacity (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 of Days working on shift basis
Product & Present Installed Maximum Prod. Proposed Installed Maximum Prod.
By-product if any Capacity Achieved Capacity of 1st Year envisaged
70.00% 331850

9.3 State the manufacturing process in brief :

9.4 Has the proposed process ever been tried in the
country or newly adopted? :

9.5 Technical Arrangements :

9.6 Describe arrangement for Key Official

for managing the proposed unit :
Technical Manpower

Administrative Manpower

Accounting personnel

9.7 Particulars of Land Existing Proposed

Location of the Land :
Area of Land
Status of the Land
Nature of Land
Availability of Water :

9.8 Particulars of Building Existing Proposed

(Enclose the plan & Estimation for the proposed Building) Area Value in Rs. Status Area Value Status
Factory Building :

Ancillary Building

Storage

Total 0.00 0.00

9.9 Plant and Machinery Existing (Value in Rs.) Proposed (Value in Rs.)
Indigenous 50000.00

Imported

(Enclose the plan layout of the existing plant and machinery )

9.10 Rawmaterials / Components
Req. of Raw material/Components/Chemicals Qty. in Nos./Kgs./Ton Rate/Nos./Kgs/Tons Value in Rs.

Total 0.00

9.11 Utilities (Furnish details on requirement, availability, adequacy, qualitative aspects etc..)
Particulars of Utilities Contracted Load Connected Load Further requirement
in HP/KW/W in HP/KW/W in HP/KW/W
Power

Water

Fuel

Others (Specify)
9.12 Environment Aspect of the Project :

9.13 Requirement of Manpower for the Project :

Particulars of Manpower Total Requirement Salary/Wages per month Cost per Annum
LABOUR 2 6000.00 144000.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
MANAGER SELF 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 2 144000.00

9.14 Schedule of Implementation : BAR CHART

Activities Date of Commencement Expected Date of Completion
a. Acquisition of Land
b. Development of Land
c. Civil Works for Factory / Building
Machinery / Foundation etc..
d. Plant & Machinery
Imported
Indigenous
e. Arrangement for power
f. Arrangement for water
g. Errection of equipment
h. Commissioning
I. Procurement of Raw materials/Chemicals
j. Trail Runs
k. Commercial Production
10 Cost of Project :
(Rs. in '000)
Sr.No. Particulars Already Incurred To be Incurred Total Cost
A Land including Development 0.00 0.00

B Building & Other Civil Works 125000.00 125000.00

C Plant and Machinery

1. Indigenous 50000.00 50000.00
2. Imported 0.00

D Furniture & Fixture 10000.00 10000.00

E Testing equipment 0.00

F Miscellaneous Fixed Assets 0.00

G Errection & Installation Charges 0.00

H Contingency 5000.00 5000.00

I Preliminary & Pre-Op. Cost 10000.00 10000.00

J Provision for
1. Buildings 0.00
2. Plant & Machinery 0.00
3. Other Fixed Assets 0.00

K Working Capital for one 15427.00 15427.00

Operating Cycle

L Total 0.00 215427.00 215427.00

 11 Means of Financing :
(Rs. in '000)
Sr.No. Particulars Amount already Amount Proposed Total
Raised to be Raised
A Equity / Promoters Contribution 10771.00 10771.00

B Reserves 0.00

C Term Loans 204656.00 204656.00

D Unsecured Loans and Deposits 0.00

(Indicate sources, roi, repayment etc)

E Deferred Payment 0.00

Arrangements including Suppliers credit

F Subsidy
Central Government 75399.00 75399.00
State Government 0.00

G Seed Capital 0.00

H Internal Cash Accruals 0.00

I Other Sources (Specify) 0.00

J Total 0.00 215427.00 215427.00

11.1 In case internal accruals are taken as

source of finance explain the basis of
estimation of internal accruals :

11.2 Indicate source from which expenditure

already incurred has been financed :

11.3 % of Promoters contribution of the :

total cost of project
 12 Marketing & Selling Arrangements of the Product :

13 Projected Profitability : Projected Profitability Statement given in the

Detailed Project Report.

14 Projected Cash flow Statement : Projected Cash flow Statement given in the
Detailed Project Report.

% of Cash Sales in Total Sales :

Period in which payment is received Days

in respect of Credit Sales

Average Credit Available on Purchase : Days

15 Working Capital Required for the : Rs. 15427.00

anticipated turnover

16 Repayment Programme : Detailed Repayment programme for Term loan and

Working capital loan have been given in the DPR.

17 Details of Securities to be Offered :

17.1 Primary ( Furnish details for term loan and : :

working capital loan separately )
17.2 Collateral, if any (Details) :

17.3 Details of Guarantor(s) :

1. Name
2. Residential Address :

3. Occupation :
4. Details of movable & immovable
properties owned by him /her/other
family members

5 Details of any other similar guarantees:

if any, given to other institutions

18 Government Consents :
(Give deatails of various licenses / consents required to be obtained from various authorities for the proposed project)

19 DECLARATION

I / 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 particulars

Date : 0 Signature of the Borrower

Place : 0 Name & Designation (In case of Regd. Inst.)
 Project Report on

Prepared By:
#REF!
District Industries Center
#REF!
#REF!
#REF! State: #REF!
e-Mail:
Ph. No.: Fax: