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MSMED Declaration Form
MSMED Declaration Form
Add: Block K1/ 187, New Palam Vihar, Sector 110, Gurgaon, 122017
Mb. - 9596688488
a) Not registered [ ]
b) Registered as [ ]
• Micro Enterprise [ ]
• Small Enterprise [ ]
• Medium Enterprise [ ]
Under “Micro, Small and Medium Enterprises Development Act 2006” (MSMED)
Note: If applicable then please attach copy of proof of valid document / certificate (indicating
Registration Number) of being Micro / Small / Medium Enterprises.
In future, if we / I will register our firm / entity under MSMED Act, we will communicate the same to you
along with all required documents / registration numbers.
Name : S K Singh
Designation: Owner
Rubber Stamp:
Place: Gurgaon
Date: 1 Jun 23