COMMON APPLICATION FORM

For space booking for participation in International / Domestic Exhibition through NSIC

Enter GST Number of Applicant :

1 Exhibition
Details
a Name, venue &
Dates

2 Organization
Details of units
seeking
assistance from
NSIC
a Name (with
website, if any)
b Category as per
EM part-II
(please tick the Manufacturing Service
appropriate
column)*
c Investment in Does not More than Rs. 25 More than 5 Does not More than More than
plant & exceed Rs.25 lac lac but does not crore but does exceed Rs.10 lac Rs. 10 lac Rs. 2
Machinery as per exceed Rs. 5 crore not exceed but does not crore but
MSMED Act Rs. 10 crore exceed Rs.2crore does not
2006 exceed
Rs. 5
crore
(Please tick
appropriate
column)
Udyog Aadhar
Memorandum
d (UAM) No.
Registered in
e MSME Databank Yes No

f IEC Code No.

g Category of Gen. Scheduled Scheduled Women North- Backward Minority ISO Hilly J&K
promoter (attach Caste Tribe entrepreneurs East 9001 Area
documents in r/o unit
SC, ST, Women
or NER)
(Please tick
appropriate
column)
h Name of
Promoter/
Chief Executive
i
Contact Person
j Address

k Factory/Unit
address

l Contact details Phone Fax Mobile Email

m Promoter’s
Residence
address

3 Exhibit Details

a Nature of Machines Equipments Brochure display etc. Electronics Any other

Display proposed (audio/ visual etc.) (Pl. specify)
in the exhibition display of products
& services
Pl. tick the
appropriate
column(s)
b Approx. weight
of the
products/machine
(for participation
in international
exhibition only)
c
Dimensions of
the products/
machines (for
participation in intl.
exhibition only)
4 Passport Details (for participation in international exhibition only)
a Name as in Passport Date of Birth Passport No. Place of Issue Date of issue Date of Expiry

5 Short name of the

company on fascia
(Max 20 character)
6 Space requirement 6 sqm 9 sqm
(Minimum under
shell scheme)
7 Payment Details DD No. Issuing Bank Date Amount (in Rs.)

8 Whether the unit sought assistance from the corporation during the last two financial years under Yes No
Marketing Assistance Scheme. (Please Tick)
a If Yes please provide the details Name of the Exhibition participated NSIC Branch which sanctioned

9 I have read the terms and conditions of Marketing Assistance Scheme for participation through NSIC and agree to abide by them.
The above information, as provided by me, is correct true to my belief.

Date: Place: Signature:

Exhibition Division, National Small Industries Corporation Ltd.

NSIC Bhawan, Okhla Industrial Estate, New Delhi-110020
Tel. 011-26926275, Fax 011-26928195
Email: exhb@nsic.co.in, website: www.nsic.co.in