Project Application Form

Applicant Details

1. Applicant First Name:

2. Applicant Middle Name:

3. Applicant Last Name:

4. Applicant Designation:

5. Applicant Phone Number:

6. Applicant Fax No:

7. Applicant Mobile Number:

8. Applicant Email ID:

9. Applicant Address Line 1:

10. Applicant Address Line 2:

11. Applicant Country:

12. Applicant City:

13. Applicant State / UT:

14. Applicant District:

15. Applicant Taluka:

16. Applicant Village:

17. Applicant PIN Code:

Company Details

1. Name of Enterprise:

2. Registered Company Address Line 1:

3. Registered Company Address Line 2:

4. Registered Company Country:

5. Registered Company City:

6. Registered Company State / UT:

7. Registered Company District:

 8. Registered Company Taluka:

9. Registered Company Village:

10. Registered Company PIN Code:

11. Date of Incorporation:

12. Organization Type:

13. Type:

14. In case of partnership Firm, whether the deed of partnership is registered?

15. Registration No.:

16. Registration No. in case of Cooperative Society:

17. No. given by the register of Companies in case of private/public limited companies:

18. Company PAN Number:

19. Website:

20. Is your project situated SEZ / SIR:

Project Details

1. Name of Project:

2. Whether proposed work is for:

3. Project Address Line 1:

4. Project Address Line 2:

5. Project Country:

6. Project City:

7. Project State / UT:

8. Project District:

9. Project Taluka:

10. Project Village:

11. Project PIN Code:

12. Survey Number:

13. Plot / Sub Plot / Shed No.:

14. Ward No/Nearest Landmark:

 15. Type of Industry:

16. NIC Code:

17. Does your industry unit fall under the category of white industries exempted from obtaining
Consent to Establish under GPCB??

18. GPCB District Name:

19. GPCB SIDC Name:

20. GPCB Taluka Name:

21. GPCB Village Name:

22. Project Phone Number:

23. Project Fax No:

24. Project Mobile Number:

25. Project Email ID:

26. Relevant Urban Local Body:

27. Expected Date of Commencement:

28. GPCB Code:

Investment Details

1. Investment in Land (INR):

2. Investment in Plant and Machinery (P & M) (INR):

3. Investment in equipment:

4. UAN/EMN/SSI/IEM Number:

5. Type of Unit:

Correspondence Address

1. First Name:

2. Middle Name:

3. Last Name:

4. Phone Number:

5. Fax:

6. Mobile Number:
 7. Email ID:

8. Address Line 1:

9. Address Line 2:

10. Country Name:

11. City Name:

12. State Name:

13. District Name:

14. Taluka Name:

15. PIN Code:

Other Details

1 . Power Required (KVA):

2. Do you need electrical Plan approval?

3. Type of power connection required:

4. Power Category:

5. Do you require a Water Connection?

6. Water Connection Category?

7. Will your enterprise have steam Boiler?

8. Do you intend / employ 10 or more contract labourers?

9. Will you be falling Trees on your premises?

10. Do you need Building Plan Approval?