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16
 Annexure-1

Registration Form

{Unique ID generated on submission}

SI. Head Details Supporting documents

Certificate of Incorporation,
1 Name of applicant registered partnership deed,
trust /society registration deed
Contact details of applicant

Email Certificate of Incorporation,

2 registered partnership deed,
Mobile trust /society registration deed

Address
3 PAN No of applicant Copy of PAN
Name of proposed R&D Centre/
4
COE
5 Brief Project details
6 Location of proposed project
Constitution (Society/ Trust/
7 Copy of registration/ deed/ etc.
Others)
Promoter/ Director information (Supported
. by
- CODV of PAN & DIN numbers) -,
Contact Details
SI Name Designation PAN & DIN Numbers
(Address/ Mobile/ Email)

9 Proposed Project cost (INR Cr)

10 Details of authorised signatory
Name
Designation
Contact details
Email Copy of Board Resolution
Phone no
Address
PAN No
Beneficiary Bank Details (Name,
11 Account No, Name of Bank, IFSC Copy of Bank Passbook
Code)
 Annexure-2

Application Form for Sanction of Letter of Comfort

under UP IIEPP 2022

Part-A: Project Details

SI Head Details Supporting documents

Nivesh Mitra Registration
1 Unique ID No.
Form
Name of proposed R&D
2 Project Report (CA certified)
Centre/ CoE
3 Brief Project details Project Report (CA certified)
Location of project

4 District Project Report (CA certified)

Region
Proposed project cost
5 Project Report (CA certified)
(INR Cr)

Part-B: Incentives requested -

<Select the relevant>

Si Item Details
Incentive for Standalone R&D facility (INR Cr)

Subsidy on Standalone R&D

1
Subsidy on Registration of Patent/
Copyright/ Trademark/ G.I Registration
2 Grant for CoE (INR Cr)
3 If any incentive claimed under any Gol incentive? (Y N)
3A If Y - Name of such Scheme
3B If Y - Incentive claimed (INR Cr)

Note: Besides submitting the formats prescribed in these rules, the applicant will have to
submit the following supporting documents as well -

Project Report (DPR) should be prepared by external consultant / Chartered

Accountant

Charted Accountant's Certificate for break up of Project Cost

 Annexure-3

Application Form for Disbursal of Incentives

under UP IIEPP 2022

Part-A: Project Details

Si Head Details Supporting documents

1 Unique ID No. Nivesh Mitra Registration Form
2 LoC No & Date of Issuance Copy of LoC sanctioned
Name of proposed R&D Centre/
3
CoE
Location of project
Enclose certificate from concern
4 District GM DIC or Chartered
Accountant
Region
C.A certified Investment Break
5 Actual Project cost (INR Cr)
up
6 Date of project completion

Part B- Incentives claimed -

<Select the relevant>

Incentive for Standalone R&D facility (INR

Cr)
1 Subsidy on Standalone R&D
Subsidy on Registration of Patent/ Copyright/
Trademark/ G.I Registration
2 Grant for COE (INR Cr)
(3) Declarations of incentives claimed (instalments under IIEPP 2022
3A Number of instalments of incentive already
claimed
3B Incentive instalment already claimed INR Cr)
SI Incentive Head Incentive Amt (Rs Cr)

(4) If any incentive claimed under any Gol

incentive? (YIN)
SA If Y - Name of such Scheme
SB If Y - Incentive claimed under such scheme (INR
Cr)
 <Format - 1>
FORMAT FOR PROIECT REPORT (Suggestive).

1 Executive Summary

The Project

2.1 Details of Project

2.2 The Company- (Including Details of Group Companies & Financial

Performance during last 3 years)

2.3 Promoters' Background

2.4 Details of Standalone R&D Facility (if any)

2.4.1 Title, Location (Inside/ Outside premises)

2.4.2 Purpose, Objective, Expected outcome

2.4.3 Details of the research work including benefits to

manufacturing sector/ industry, social impact,

2.4.4 Capital Cost for the research work - Land, Building, Plant 82.
Machinery, Equipment, Tools, Technology acquired & other Fixed
Assets

2.4.5 Collaborations/ Expertise acquired for the research

2.4.6 Status of registration with the Department of Scientific and

Industrial Research, Government of India (DSIR)

2.5 Present Status of the Project

Means of financing

3.1 Equity: - Promoters' Contribution & Source/Internal Accruals/Details

of Fund Arrangement from External Sources etc.

3.2 Debt Contribution Source & Cost of Debt

Land Details & Logistics

4.1 Character of Land

4.2 Requirement of Land Area

 4.3 Ownership of the Land

4.4 Present Status of Land

4.5 Location of Land

Details of Proposed Building- Section wise Layout, Measurement,

Type of Construction etc.

Details of Plant & Machinery & MFA

6.1 Technology Used

6.2 Possible Source of Equipment's/Machine Suppliers

6.3 Cost & Quantity

6.4 Specification & Supplier

6.5 Erection & Commissioning Arrangement

6.6 Pollution/Wastage- Controlling Measures

6.7 Machines to be installed for adhering to pollution norms

Details of Manpower

7.1 Manpower requirement & availability

7.2 Team size & qualification

7.3 Consulting fees & Costing

R&D Innovation Strategy & Outcome

 Format 2

Details of Proposed/ Actual Project Cost of Standalone R&D & COE

Sl. Head Details
1 Name of proposed R&D facility
2 Location
Address
3 Brief objective & purpose of R&D facility
4 Outcome of the facility
5 Project Cost (Rs Cr)
Break-up of Costs incurred in following heads -
Plant & Machinery
Office Equipment
C. Tools
d. Any other fixed asset
a Registration costs incurred on acquiring Patents/
Copyrights/ Trademark/ G.Is
6 Means of finance (Rs Cr)
Host Industrial unit
Financial Institute
C. Other Sources
Total
7 Year wise work plan of proposed R&D
Note: Applicant must submit this Format certified by an external CA.

Supporting documents -

(A) Required at the stage of LoC Sanction

Prescribed DPR in the required format

Affidavit on a stamp paper stating that the host industrial unit has not claimed any
assistance from any other departments of State Govt/ Gol for the said R&D unit

(B) Required at the stage of Disbursal

Copy of documents for registration of the Standalone facility with the Department of
Scientific and Industrial Research, Government of India (DSIR)

Copy of supporting bills/ invoices of the P&M, Equipment, Tools, etc.

Copy of certificates/ documents of Patents/ Trademarks/ Copyrights/ Geographical

Indicators acquired/ registered.

Affidavit on a stamp paper stating that the host industrial unit has not claimed any
assistance from any other departments of State Govt/ GoI for the said R&D unit
 <Format - 3>

Declaration

The information provided while filling online form on Nivesh Mitra Portal to avail
sanction of incentives under UP IIEPP 2022 is completely true, and no fact has been
concealed or misrepresented. It is further certified that the company has not applied
for benefits under any sector-specific or other policy of the Government of Uttar
Pradesh.

It is also certified that, the details of financial assistance taken from Government of
India Schemes, if any as provided in the application is true and in case of
any dovetailing of this scheme with Central Government policies/schemes, the
Company would not claim incentives more than upper ceiling defined in the policy
from all the schemes put together and in such a case Government of Uttar Pradesh
financial assistance shall be reduced to that extent.

I/we hereby agree that I/we shall forthwith repay the benefits released to me/us
under UP IIEPP 2022, if the said benefits are found to be disbursed in excess of the
amount actually admissible whatsoever the reason.

Signature of Authorised Signatory with

Name, Designation and Office Seal

Date:

Place: