department of industries & export promotion _ form-1 (print)

8212015 Department of Industries amp Export Promotion | Formshy1 (Print)

httpeudyoguttarpradeshinfrmPart1Printaspxappid=208252ampuserid=148158ampapptypeid=1 12

ENTREPRENEURS MEMORANDUM FOR SETTING UP

MICRO SMALL OR MEDIUM ENTERPRISE

PART shy1 (TO BE FILLED IN AS EXPRESSION OF INTENT)

Form no 04131

PERSONAL DETAILS

1 Name Of Applicant sarthak goel2 Communication Address

Address Proposed ForCommunication 42 avas vikas colony civil lines bareilly uttar pradesh

Telephone Number(WithSTD CODE) 05812510637 Fax Number

Mobile Number 7895788655 EshyMail Permanent Address Permanent Address 42 avas vikas colony civil lines bareillyshy 243001 up

Telephone Number(WithSTD CODE) 05812510637 Fax Number

NAME AND LOCATION OF ENTERPRISE

3 NameProposed OfEnterprise crystal beverages

PAN Card NumberVoter Id NoVoter Id Name

Website for Enterprise Mobile Number Eshymail4 Location Of Enterprise State UTTAR PRADESH District BAREILLY Tehsil Faridpur RuralUrban Rural Pin Code 243201

Proposed Enterprise FullAddress

BAHADURPUR KAKOD MOD VILLAGE RAJAU PARASPUR TEHSIL FARIDPURBAREILLY

NATURE OF ENTERPRISE(MANUFACTURINGSERVICE)

5 Category Of Enterprise Small6 Nature Of Activity Manufacturing7 Nature Of Operation Casual8 Wheather the unit will be Anciliary No9 Proposed Schedule of Installation of

Plant and machinery(mmyyyy) 122015

10 Start Date of Plant andmachinery(ddmmyyyy) 15012016

11 Type Of Organization Proprietary

PRODUCTS SERVICE OF ENTERPRISE

12aMAIN MANUFACTURING SERVICE CODE (NIC 2004)

Product Name NIC CODE 2004

Mineral water edible 1554312bPRODUCTS TO BE MANUFACTUREDSERVICE TO BE PROVIDED CODE (ASICC 2000)

Product Name ASICC CODE 2000

Mineral water edible 15221 Corresponding codes are defined by Development Commissioner MicroSmall And Medium Enterprise

Government Of India 13 Proposed Investment in Fixed Assests (Rs in Lakh) Land Pvt Leased Approx Value 35000 Rs in Lakh Building Self Owned Approx Value 18000 Rs in Lakh Plant and Machinery Value

(In case of manufacturingenterprise)

30000 Rs in Lakh



Equipment Value (In case ofservice enterprise) 000 Rs in Lakh

Enterprenuer ShareMargin 000 Rs in Lakh Loan Proposed 000 Rs in Lakh

Source Of Finance Private Borrowing 14 INSTALLED CAPACITY (proposed) PER ANNUM Product QTYYear Unit

Mineral water edible 240000 CUM

15 POWERLOAD (ANTICIPATED) 30000 KW 16 OTHER SOURCE OF ENERGY POWER [If REQUIRED] Energy Source QTY Unit

NO OTHER POWER SOURCE NEEDED 0 K W

EXPECTED EMPLOYMENT

Male Female Total17 i) MANAGEMENT AND OFFICE STAFF 1 1 2

ii) SUPERVISORY 3 1 4iii) WORKERS 10 2 12

ENTREPRENEURS PROFILE

18 ENTREPRENEURS PROFILE( ALL PARTNERSDIRECTORS OF ALLORGANISATION)ENTERPRENUERS SHARES IN OTHER ORGANISATIONS

(i) NAME sarthak goel (Proprietor) (v) KNOWLEDGE LEVEL Any Other (ii) GENDER Male (vi) CATEGORY General (iii) ENTERPRENUER

SHAREMARGIN 000 Rs in Lakh (vii) ENTERPRENUERSHAREMARGIN() 000

(iv) STAKE IN OTHERENTERPRISES Yes (viii) STAKE IN OTHER

ENTERPRISES() 000

(ix) Is Under MinorityGroup No

19 EXPECTED SCHEDULE OF COMENCEMENT OF PRODUCTION SERVICE(mmyyyy) 082015

UPLOADED DOCUMENTS

Document For Document Name PROOF OF LAND image1JPG Downloadproof of land image2JPG Downloadproof of land image3JPG Downloadproof of land image4JPG Download

UNDERTAKING

This is to certify that information furnished in the Entrepreneurs Memorandum PartshyI in Form No 04131 is true and correct to the best of my knowlegde and belief

IN CASE THE CERTIFICATION ACKNOWLEDGMENT OF THE BANNED ITEMS UNDER THE ACTSRULES AND REGULATIONS OF GOVERNMENT OF UTTAR PRADESH OR GOVERNMENT OFINDIAHONOURABLE HIGH COURTHONOURABLE SUPREME COURT IS WRONGLY ORNEGLIGENTLY OBTAINDED BY THE UNIT THEN ENTREPRENEURS MEMORANDUM PARTshyI WILLBE TREATED INVALID AND SHALL HAVE NO LEGAL FORCE

Date 21082015

Place BAREILLY [NAME AND DESIGNATION OF THE APPLICANTAUTHORISED PERSON]

sarthak goel

This is a computer generated letter hence no signature is required You can use this document in yourfurther dealing



Equipment Value (In case ofservice enterprise) 000 Rs in Lakh

Enterprenuer ShareMargin 000 Rs in Lakh Loan Proposed 000 Rs in Lakh

Source Of Finance Private Borrowing 14 INSTALLED CAPACITY (proposed) PER ANNUM Product QTYYear Unit

Mineral water edible 240000 CUM

15 POWERLOAD (ANTICIPATED) 30000 KW 16 OTHER SOURCE OF ENERGY POWER [If REQUIRED] Energy Source QTY Unit

NO OTHER POWER SOURCE NEEDED 0 K W

EXPECTED EMPLOYMENT

Male Female Total17 i) MANAGEMENT AND OFFICE STAFF 1 1 2

ii) SUPERVISORY 3 1 4iii) WORKERS 10 2 12

ENTREPRENEURS PROFILE

18 ENTREPRENEURS PROFILE( ALL PARTNERSDIRECTORS OF ALLORGANISATION)ENTERPRENUERS SHARES IN OTHER ORGANISATIONS

(i) NAME sarthak goel (Proprietor) (v) KNOWLEDGE LEVEL Any Other (ii) GENDER Male (vi) CATEGORY General (iii) ENTERPRENUER

SHAREMARGIN 000 Rs in Lakh (vii) ENTERPRENUERSHAREMARGIN() 000

(iv) STAKE IN OTHERENTERPRISES Yes (viii) STAKE IN OTHER

ENTERPRISES() 000

(ix) Is Under MinorityGroup No

19 EXPECTED SCHEDULE OF COMENCEMENT OF PRODUCTION SERVICE(mmyyyy) 082015

UPLOADED DOCUMENTS

Document For Document Name PROOF OF LAND image1JPG Downloadproof of land image2JPG Downloadproof of land image3JPG Downloadproof of land image4JPG Download

UNDERTAKING

This is to certify that information furnished in the Entrepreneurs Memorandum PartshyI in Form No 04131 is true and correct to the best of my knowlegde and belief

IN CASE THE CERTIFICATION ACKNOWLEDGMENT OF THE BANNED ITEMS UNDER THE ACTSRULES AND REGULATIONS OF GOVERNMENT OF UTTAR PRADESH OR GOVERNMENT OFINDIAHONOURABLE HIGH COURTHONOURABLE SUPREME COURT IS WRONGLY ORNEGLIGENTLY OBTAINDED BY THE UNIT THEN ENTREPRENEURS MEMORANDUM PARTshyI WILLBE TREATED INVALID AND SHALL HAVE NO LEGAL FORCE

Date 21082015

Place BAREILLY [NAME AND DESIGNATION OF THE APPLICANTAUTHORISED PERSON]

sarthak goel

This is a computer generated letter hence no signature is required You can use this document in yourfurther dealing

department of industries & export promotion _ form-1 (print)

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