Anda di halaman 1dari 12

Part I

Government of Tamilnadu
Department of Industries and Commerce
jHehL muR
bjhy tf Jiw

APPLICATION FORM
FOR FINANCIAL ASSISTANCE UNDER
THE NEW ENTREPRENEUR -CUM- ENTERPRISE DEVELOPMENT SCHEME (NEEDS)
a bjh Kidnth kW bjh Wtd nkghL l (NEEDS)
j bgWtjfhd zg

PLEASE AFFIX
LATEST PASSPORT SIZE
PHOTO
(rg vLfgl
ghngh ms
ifgl xl)

1. Name of the applicant in Block letters


tpz;zg;gjhuhpd; bgah; bghpa vGj;Jf;fspy;

2. Fathers / Spouses Name : jfg;gdhh; /fztd; / kidtpapd; bgah;

3. Gender : ghypdk; Male / Mz; Female / bgz; Transgender / jpUe=;ifah;

4. a. Are you Married? / jh=;fs; jpUkzk; Mdtuh> Yes/ M No/ iy


b. Are you a Differently Abled person?
Yes/ M No/ iy
jh=;fs; xU khw;Wj; jpwdhspah>
c. Are you an Ex-serviceman?
Yes/ M No/ iy
jh=;fs; xU Kd;dhs; uhQtj;jpduh>
5. a. Date of Birth D D M M Y Y Y Y
gpwe;j njjp

b. Age on the date of application: Years Month


tpz;zg;gpf;Fk; ehs; md;W taJ taJ khjk;

6. Community / tFg;g[
SC ST BC MBC Minority Differently Ex- Service General
M gH wgl f Wghik Abled man bghJ
uhl Fod tFd wgl d khW Kdh d
tFd wdhf uhQtd

7. Particulars of Educational Qualifications: fy;tpj; jFjp Fwpj;j tptu=;fs;

Educational Qualification Course Details Year of Passing


fy;tpj; jFjp go tuf nj bgww ML
i. Graduate / Post Graduate Degree
sfiy /KJfiy gl go

ii. Diploma
gla go

iii. Certificate obtained from ITI /


Vocational Training from recognized
Institutions.
IoI / mffgl gw
Wtdfs _y bgwgl
bjh g rhdjH

8. a. Whether undergone any Entrepreneur Development


Training Programme? Yes/ No/
jF K bjh Kidnth nkghL M iy
g bgwWsshuh?
b. If yes, give details. M v mj gu
Period of training
Name of the Course Name & Address of Training Institute g fhy
g bga g Wtd bga & Kft From To
Kj tiu

9. Employment Details: ntiy gu


a. Self: zgjhu
i. Whether the applicant is presently employed ? Yes/ No/
zgjhu jnghJ ntiy Ugtuh? M iy
ii. If yes, give details. M v guf
iii. If No, whether registered with Employment Registration No. Date
Exchange? (Give registration No & Date) g v eh
iyba ntiy th mYtyf
g brJs g v kW eh

2
b. Occupation of Father/Spouse
jij/ fzt/kid brJ tU ntiy
c. Whether any one in your family is self employed ?
jf FLg cWdf vtnuD Yes/ No/
M iy
Ra bjh braJ tUwhuh ?
d. If yes, give details. M v mj gu
10. Communication Details / bjhlh;g[ tptu=;fs; :
a. Residential Address: Ul Kft
D.No/Street:
fj v

Village/Town:
uhk/efu

Block:
xa

Taluk:
tl

District:
khtl
Pin Code:
mryf FpL v

b. Email Id
dr Kft
c. Mobile No
ifng v
11. whether residing in the above address for at least 3 years
Yes/ No/
nkFl Kft flj _W MLfshf M iy
bjhlJ tJ tUfsh ?
12. a. Name of the activity proposed to be established :
Jtf cnjJss bjh
b. Whether Manufacturing/Service activity :
cg Wtd myyJ nrit Wtd
c. Address of proposed location of Enterprise :
bjh Jtf cnjJss l KG yhr
D.No/Street:
fj v

Village/Town:
uhk/efu

Block:
xa

Taluk:
tl

District:
khtl
Pin Code:
mryf FpL v

d. Entrepreneur Memorandum (Part I) No obtained from District Industries Centre


khtl;l bjhHpy; ikaj;jpy; ,Ue;J bgwg;gl;l bjhHpy; Kidnthh; gjptwpf;if (ghfk; 1) vz;.
No. 3 3 Part I

Date of Issue

3
13. Previous experience if any. :
K mDgt VJU mj gu
14. Project Outlay: l KjL

Means of finance (In Lakh Rs)


Project Mjhu (%.yr)
Cost
Sl.No Item (In Lakh Rs) Own Govt.
contrib Bank Subsidy
t.v gu
Total
l bjhif -ution Loan @ 25%
(%.yr) t bkhj
brhj muR
KjL fl kha
Land
1.
y
Building
2.
fol
Machinery or Equipment
3.
au jsthlf
Margin Money for working
Capital
4. eilKiw _yjdfhd
bjhif
Preliminary & Pre-operative
5. expenses
Mug fl brydf
Other expenses (Technical
know-how extra)
6. ,ju bryt[fs; (bjhHpy;El;g
Mnyhrid bryt[fs; nghd;wit)
Total
bkhj
15. a. Whether availed loan under any Central / State Government
subsidy linked loan schemes? Yes/ No/
jwF Kd ka / khy mu khaJld Toa M iy
fld bgwwtuh?
b. If yes details of the loan obtained .
M vy mtthW bgwgl fl guf

Name of the Loan Amount


Name of Name of Subsidy Year of
scheme received
activity Bank Branch amount Sanction
fld ( in Rs)
ld t kwW kha mDkfgl
ld bgw gl
bga is bga bjhif ML
bga fld bjhif

I certify that all the informations furnished by me are true; and I have not availed any financial
assistance from banks under any subsidy linked scheme of Central/State Government for
establishing any enterprise.
nkny Twgl tuf midJ cikahdit vd eh bjh Wtdfis
W elj ka kW khy mud khaJl Toa flDj VJ t _y
bgwiy vd rhwnw.

Date : Signature of the applicant


eh zgjhu ifbag

4
Part II
For Office Use Only

Recommendations of the General Manager, District Industries Centre

As per the information provided by the entrepreneur in the application and by


verification of the documents produced by the entrepreneur as well as by conducting personal
inspection of the residence of the entrepreneur, it has been ascertained that the entrepreneur is

i) a first Generation entrepreneur Yes/No


ii) a resident of the place mentioned in Col.10 for not less Yes/No
than 3 years.
iii) aged above 21 years and not completed 35 years for Yes/No
General Category (45 years for Special Category)
iv) He / She possess the minimum Educational Yes/No
Qualifications required
v) He / She has not availed any financial assistance Yes/No
from banks under any subsidy linked scheme of
Central / State Government

Hence he/she is tentatively considered eligible for availing assistance under NEEDS
Scheme. His/her the application is recommended for placing before the District Level Task
Force Committee.
Or
The application is rejected for the reasons mentioned below.

1.
2.
3.

Date :

Signature of the General Manager


District Industries Centre

5
Part III
For Office Use Only
Recommendations of the Task Force Selection Committee
Name of the applicant
Application No:
Date of Task Force Selection
Committee
Name of activity
Whether Manufacturing or
Service activity
Bank
Recommended to
Branch
Project Cost

Break-up of the Recommended Project Cost


Means of finance (In Lakh Rs)
Project
Sl.No Item Cost Own Govt.
Bank Subsidy
(In Lakh Rs) contrib Total
Loan @ 25%
-ution
1. Land

2. Building

3. Machinery / Equipment

Margin Money for working


4. Capital

Preliminary & Pre-operative


5. expenses
Other expenses (Technical
6. know-how)

Total

Signature of Task Force Selection Committee members


District Employment
Lead Bank Manager
Officer
Branch Manager TIIC District Manager,
TAHDCO
Branch Manager, SIDCO Representative of
MSME-DI
Branch Manager, Representative of EDI
.............. Bank
Branch Manager, Representative of District
................. Bank MSME Association
Convenor - General Manager Chairman -
District Industries Centre District Collector

6
THE NEW ENTREPRENEUR -CUM- ENTERPRISE DEVELOPMENT SCHEME (NEEDS)
a bjh Kidnth kW bjh Wtd nkghL l (NEEDS)
Instructions to Applicants / zgjhufSfhd Kiwfs
The applicant should have completed minimum 21 years but
1. Age
should not have completed 35 years for General Category and
taJ tu 45 years for Special Category of Entrepreneurs on the date of
application.
zgjhu zF nj mdW 21 taJ
Kotilj tuhf, bghJdiu rhjtuhf Ud
35 tawF fhj tuhf wdiu rhjtuhf
Ud 45 tawF fhjtuhf Ujy ntL.
Women/ SC/ST/BC/ MBC/ Minorities/ Ex-Servicemen/Trans
2. Special Category of genders/ differently abled persons.
Entrepreneurs kf/M uhl / gHFod / wgl tFd/ f
w bjhy Kidnth wgl tFd / Wghdikd / Kddhs uhQtd /
Ueifa /khwW wdhfs.

3. Academic Qualification Degree, Diploma, ITI / Vocational Training from recognized


Institutions.
fy jF
gl go, gla go, ITI / mffgl gw
Wtdfs _y bgwgl bjh g .

4. Place of residence The applicant should be a resident of Tamil Nadu State for not
less than 3 years.
tl
zgjhu jH ehoy flj _W MLfshf
bjhlJ tgtuhf Uf ntL.

5. Eligible activities All economically viable manufacturing and service activities


jFss bjhyfs (except those activities mentioned in Annexure I)
yhgfukhf braygLj jf midJ cwg kwW
nrit bjhyfs(iz-1 y FlgLss
bjhyfs ju)

6. Project Cost 1. Above Rs.5.00 Lakhs and not exceeding Rs.1.00 Crore.
l kL %.5.00 yrF nk %.1.00 nfhoF fhky
l kL Uf ntL.
2. The entrepreneur has to meet the cost of land,
rented/leased building, Technical know-how, Preliminary
& pre-operative expenses, Working capital margin etc.,
from his/her own funds
bjh Kidnth y thlif/Fjifya tU
fold k/ bjh Eg Mnyhridfhd bry,
eilKiw _yjdfhd bjhif kwW Mug fl
brydf itmidij jkJ brhj bryy
nkbfhs ntL.
3. Cost of the land may be included in the Project cost at
guideline value or market value, prevailing as on the date
of filing loan application, whichever is lower.
y k fl zg rkF nj muR
za brj kngh (m) rij kngh vJ Fiwthf
csnjh mij lky nrJ bfhsyh.

10% of the Project Cost -for General Category


7. Promoters' Contribution
bghJdUF l ko 10%
bjhy Kidnthd KjL
5% of the Project Cost - for Special Category
wdUF l ko 5%
8. Subsidy from Government 25% of the Project Cost subject to a ceiling of Rs.25.00 Lakhs.
muR _y tHfgL l koy 25% mf grkhf %. 25.00 yr tiu.
kha cj
9. Items eligible for Cost of land to be purchased anew in the name of the
subsidy Beneficiary or Enterprise , Cost of Building to be
kha cj bgw purchased/constructed and cost of Plant, Machinery &
jFila KjLfs Equipments
zgjhud bganyh myyJ Wtdd bgay jhf
thfgL yd k, jhf thfglss /flglss
bjhwTl kwW , jhf thfglss aufs
jsthlfs kwW cgfuzfd k.

10. Items not eligible for The cost of rented/leased building, Technical know-how,
subsidy Preliminary & pre-operative expenses, Working capital margin
kha cj bgw etc., cost of second-hand machinery (except imported second-
jFyyhj KjLfs hand machinery directly imported by the entrepreneur)
thlif/Fjify a tU bjhwTl fold k/
bjh Eg Mnyhridfhd bry, eilKiw _yjdfhd
bjhif kwW Mug fl brydf giHa aufs
(bjhy Kidnthuhy neuoahf wFk braagl giHa
aufs ju)

11. EDP Training Selected applicants have to undergo a compulsory EDP


bjhyKidnth Training programme for one month.
nkghL gw
flDjtp bgw njh;t[ bra;ag;gl;l tpz;zg;gjhuh; xU khj
bjhHpy; Kidnthh; nkk;ghl;L gapw;rp fl;lhakhf bgw ntz;Lk;.
12. Eligibility of One or more entrepreneurs can jointly establish Partnership
Partnership firms Enterprise under this scheme provided all the partners satisfy
gFjhu Wtdfd the eligibility criteria. However, EDP training will be provided to
jF only one of the partners authorized by other partners in such
cases.
XdWF nkwgl bjhy Kidnth Tlhf nrJ
gFjhu Wtdfs mikf ld H cj
bgwyh. mtthW cj bgw midJ bjhy KidnthU
ld H cj bgw jFbgwwtuhf Ujy
ntL. vD ju gFjhufSila rkjJld xU
gFjhuUF kLnk bjhy Kidnth nkghL gw
mfgL.

13. Ineligible Applicants The following Entrepreneurs will not be eligible under the
jF bgwh scheme
zgjhufs 1. Who have already availed assistance under PMRY, REGP,
PMEGP, UYEGP, TAHDCO or any other scheme of
Government of India or State Government.
2. Who have availed loan for economic activity
under SHG/other group activity.
3. The applicant should not be a defaulter to any Commercial
Bank / TIIC
HfhQ bjhy Kidnth ld H j
bgw jFawwtuht.
1. ka kwW khy muR _y bray gLjgL tU
PMRY, REGP, PMEGP, UYEGP, TAHDCO nghdw
j lfs _y gadiljtfs.
2. RacjFG/ ju FGk lfs _y bghUshjhu
brayghLfS fhf fld bgwwt.
3. tfs /jHehL bjhy KjL fHf _y Vwfdnt
flDj bgwW flid Ufl jtatfs.

2
14. List of documents to Application is to be submitted in Duplicate with copies of the
be enclosed with the following documents
application zg uL efyfy Hfl MtzfSld
zgJld izf rkfgl ntL.
ntoa Mtzfd
1. Proof of Age-Copy of birth certificate or Transfer Certificate
goay
from School/ College.
tawfhd mjh / Mjhu - w rhdjd efy
myyJ gs kwW fyYh khwW rhdjH
2. Proof of Residence i.e., Copy of Ration Card or Residence
Certificate obtained from Tahsildar.
Ul mjh - FLg mil efy myyJ
tlhalUJ bgwgl Ul rhdjH
3. Copy of Degree/Diploma/Certificate Course Completion
Certificate
gl / gla go/ mffgl gw Wtdfs
_y bgwgl bjh g rhdjd efy
4. Community Certificate rh rhdjH
5. Certificate in proof Ex-servicemen, Differently-abled,
Transgender, where ever applicable.
Kddhs uhQtd, khwW wdhfs, Ueifa
Mf Ud mjwFa rhdjH.
6. Project Report with projected sales and cash flow
statement for the next 3 years.
jpl;l mwpf;if kw;Wk; mLj;j 3 Mz;LfSf;fhd cj;njr
tpw;gid kw;Wk; gzg;gha;t[ mwpf;if.
7. Copy of land document if included in the Project cost
l koy yd k nrfgoUjhy
yglhd efy
8. Estimate of Building obtained from Chartered Civil
Engineer
gla fLkhd bghahslUJ bgwgl
folwfhd cnjr kL
9. Quotations for machinery or equipments .
aufs myyJ fUfd iygoay mry
kwW efy
10. Sworn affidavit obtained from Notary Public in Rs. 20/-
Stamp Paper in (Specimen format enclosed as
Annexure II)
rhdWW mYtylUJ %.20 /- kyhd Kiu
jhy bgwgl cW bkhgu.
(iz 2 y kh got jugLssJ)
11. Entrepreneur Memorandum (Part I) acknowledgment
obtained from District Industries Centre
khtl;l bjhHpy; ikaj;jpy; ,Ue;J bgwg;gl;l bjhHpy; Kidnthh;
gjptwpf;if (ghfk; 1) xg;g[ifr; rhd;W.
12. Copy of Partnership deed incase of partnership enterprise.
g=;Fjhuh; epWtdkhf ,Ug;gpd; Tl;L xg;ge;j gj;jpuj;jpd; efy;.

15. Address to which the


application are to be sent General Manager, District Industries Centre.
bghJ nkyhsh;/ khtl;l bjhHpy; ikak;.
tpz;zg;gpf;f ntz;oa
Kfthp

3
ANNEXURE - I
,izg;g[ ? 1
Activities not be eligible for assistance under NEED scheme
ld Hj bgw jFyyhj bjhyfs
1. Any activity directly connected with agriculture.
ntshikld neuo bjhlila bjhyfs
2. Sericulture (Cocoon rearing), Animal Husbandry like Pisci culture, Piggery, Poultry etc.,
gL ts, fhyeil ts,d ts, gdts kwW nfhgiz
nghdw bjhyfs
3. Manufacturing of Polythene carry bags of less than 40 microns thickness and
manufacture of carry bags or containers made of recycled plastic for storing, carrying,
dispensing or packaging of food stuff
40 ikuhdfSF Fiwthd gUkDss ghd igfs jahjy kwW cz
bghUfis nrJ itf, vLJ bryy kwW bghly fl
cgnahfgL kWRHw Kiwy jahfgl ghd igf kwW
nrk fydf.
4. Sugar
rfiu Miyf
5. Distilleries, Brewery and Malt Extraction
rhuha to rhj bjhf
6. Units utilizing Molasses/rectified spirit/de-natured spirit as raw material for
manufacture of potable alcohol.
bkhyhr / bjLfgl vrhuha / khw bragl vrhuha tiw
_ybghUshf bfhL kJghd jahj
7. Fertiliser manufacture and blending (Except bio-fertilizers)
fy cu jahj (awif cu jahjy ju)
8. Mining and Quarrying Ores, minerals etc.[Excluding polishing, cutting,
crushing, etc. of mined ores/minerals]
fk Ruf kW fkf btobaLj(btobaLfgl fkfis
bkUnfwWjy, btLjy, ciljy Ma bjhyfs ju)
9. Aluminium, Iron and Steel Smelting [Excluding foundries]
mYa kW U cUfhiy (thgl bjhyfs ju)
10. Manufacturing of intoxicant items like Beedi/Pan/Cigar/Cigarette etc.,
o, fbu, ifiy, RUL, Ffh, kW ifiy rhj nghijbghUf cg.
11. Saw Mills
ku mWit Miyfs
12. Cement
bkd cwg
13. Calcium Carbide
fha fhigL
14. Slaughter House
czfhf fheilfis btL bjh
15. Re-packing of Drugs/Medicine/Chemical, without any processing or value addition
brKiw kW k TLj VJ kUJ bghUf kW nta
bghUfis kW bghly fLj.

4
16. Azoic/Reactive Dyes
braif kW vid aToa rhaf
17. Fire Crackers
glhR bjh.
18. Industries manufacturing and or utilizing Ozone depleting substances
thbt Xnrh glyij FiwF bghUfis jahF bjhf.
19. Industries involving hazardous activities/ classified as Red category by Tamil
Nadu Pollution Control Board /Central Pollution Control Board
mghafukhd bjhyfs kwW ka /khy khRfLghL thajhy
t vd tifgLjgl bjhyfs
20. Cyanide
raidL.
21. Caustic Soda
vfhu
22. Potassium Chloride
bghlha FnshiuL
23. Nylon, Rayon & Polyester Fibre manufacturing.[Excluding manufacture of
downstream products from Nylon ,Rayon & Polyester Fibre]
ieyh, nuah kwW ghal iH jahjy (ieyh , nuah kwW ghal
iHfis _ybghUsfshf bfhL cwg braaL bgh Ufs ju)
24. Real Estate
y wgid rhj bjhy
25. All types of Business activities
midJ ahghu rhj bjyfs

5
ANNEXURE II

AFFIDAVIT

I.....................S/o or D/o or W/o................................

residing at ...................................................................................

..................................... (address) do hereby solemnly affirm and declare us under:

1) That I am a permanent resident of

...........................................................................................................................................

..........................................................................................................................................

since the past ..................... years.

2) That I am a first generation entrepreneur and no one in my family is self employed and

running any self employed manufacturing or Service Enterprise.


3) That I have not borrowed any money under any subsidy linked scheme of
Central/State Government for establishing any enterprise.

4) That I have not defaulted in repayment of any loan from any Commercial Bank / TIIC.

5) That I shall abide by the rules framed under the scheme of NEEDS.

DEPONENT

VERIFICATION

Verified that the above contents are true and correct to the best of my knowledge and belief
and nothing has been concealed therein.

Date.

NOTARY PUBLIC

Note: This affidavit should be furnished in Rs.20/- non judicial stamp paper duly attested by
Oath Commissioner (Notary Public) along with the application.