APPLICATION FORM FOR NSIC LOYALTY CARD

NSIC Branch:

1. Name of the Company

2. Name of CEO/MD/Proprietor
3. Gender (Pl. tick )
Male Female Others

4. UAM No.
5. Address (Regd. Office)
6. Email ID
7. Mobile No.
8. Type of Enterprises (Pl. tick ) Micro Small Medium
9. Social Category
General SC ST OBC
10. PAN No.
11. Name of NSIC Scheme
already availed (Pl. tick )

a. RMA(against BG) b. SPRS

c. B2B (msmemart.com) d. Tender Marketing

e. Testing at NTSCs f. f. Credit Facilitation from bank

12. Benefits of NSIC Loyalty Card on availing additional scheme

a. Concession in the rate of interest @ 0.25% at the time of renewal of the RMA-BG limit
provided unit’s Account remained regular (as per RMA-BG Policy guidelines) during the
year. The concession will be given to the unit at the conclusion of one year. Concession is
applicable only from the next year onwards after renewal of limit. Terms & conditions apply*
b. Concession in processing fees @ 0.1% under the scheme of RMA against BG in addition to
concession in processing fees allowed to the units.
c. Concession @2% on processing/membership fees/charges on all commercial activities (i.e
SPRS, B2B, TM, Testing at NTSCs)

13. Subscription fee for Loyalty Card (Valid for 5 years)- onetime fee of Rs. 100+GST@18% (Rs. 118/-)
Payment Options: -
NEFT/IMPS No. Amount: Date:

Please fill the form and submit to the NSIC base branch (Where the Unit is registered with
NSIC branch)

Date:- Signature of Authorized Person

For official use

NSIC unique No. :

For further details you may contact: Date of allotment:
The National Small Industries Corporation Ltd.
NSIC Bhawan, Okhla Industrial Estate, New Delhi - 110020, India
Toll Free No. 1800-11-1955`