Government of Tamil NaduDepartment of Industries and Commerce

Entrepreneurs Memorandum for setting up Micro, Small or Medium Enterprise

Form No.2015/33/005/11199/SARKACKNOWLEDGEMENT PART - I

M/S AADHAAR HAS FILED MEMORANDUM EXPRESSING ITS INTENT TO SET UP A SERVICING ENTERPRISE AT THEADDRESS 3-112, SELVASAMUTHIRAM, BLOCK, KEERAIPATTY, TALUK, DHARMAPURI DISTRICT TAMIL NADU PINCODE : 636903 FOR THE ITEM/ITEMS INDICATED BELOW AND THE ACTIVITY IS PROPOSED TO COMMENCE FROM MAY-2022 AS STATED IN FORM NO 2015/33/005/11199/SARK AND ALLOCATED ENTREPRENEURS MEMORANDUM NO 2015/33/005/11199/SARK/E AS BELOW:

Sl.No TYPE OF SERVICE TO BE RENDERED1 CRANK SHAFT GRINDING

NOTE: THE ISSUE OF THIS ACKNOWLEDGEMENT DOES NOT BESTOW ANY LEGAL RIGHT. THE ENTERPRISE IS REQUIRED TO SEEK REQUISITECLEARANCE / LICENCE / PERMIT REQUIRED UNDER STATUTORY OBLIGATIONS STIPULATED UNDER THE LAWS OF CENTRAL GOVERNMENT / STATEGOVERNMENT / UT ADMINISTRATION / COURT ORDERS .

DD MM YYYY

DATE OF ISSUE 11 05 2015

NATURE OF ACTIVITY (MANUFACTURING-1,SERVICES-2) 2 SERVICING

CATEGORY OF THE ENTERPRISE (MICRO-1,SMALL-2,MEDIUM-3) 2 SMALL

ENTREPRENEURS MEMORANDUM NUMBER 3 3 0 0 5 2 2 11199 E PART I

DATE: 11/05/2015PLACE: Dharmapuri

SIGNATURE (S.A.P.Vairamani)

Additional Director ofIndustries & Commerce (DIC)

Note : (1) The concerned Financial Institutions/Agencies who provide Loan/Clearance/Assistance, shall verify this Entrepreneur Memorandum FormPart I in the website http://www.msmeonline.tn.gov.in, to ascertain the genuineness / validity / cancellation using the above EM PART I Number (2) The concerned Financial Institution/Agencies who provide Loan/Clearance/Assistance, shall ascertain the eligibility of subsidies andincentives given by the Government, from the General Manager, District Industries Centre, DHARMAPURI .

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Application Id : 2015/33/005/11199/SARKApplication Date : 11-05-2015

1. Name of the Applicant : S SIVARAJ

2. (a) Address of CommunicationS/O SUBRAMANI

SELVASAMUTHIRAM VILLAGE KEERAIPATTY PO HARUR TK, DHARMAPURI DT

PIN Code : 636903

Phone : -

Phone : -

Phone : -

Phone : -

(b) Permanent Residential AddressS/O SUBRAMANI

SELVASAMUTHIRAM VILLAGE KEERAIPATTY PO HARUR TK, DHARMAPURI DT

PIN Code : 636903

Phone : -

Phone : -

Phone : -

Phone : -

3. Name of The Proposed Enterprise (if decided) : AADHAAR4. Proposed Location of Enterprise

(i). S .F.No / Door No.: 3-112(ii). Street. : SELVASAMUTHIRAM(iii). State : Tamil Nadu(iv). District : Dharmapuri(v). Taluk : (vi). Rural/Urban : Rural(viii).Town/Village : KEERAIPATTY(ix). PIN Code : 636903

5. Category of Enterprise : SMALL

6. Nature of Activity : Service

7. Nature of Operation : Casual

8. Whether Unit will be an Ancillary Unit : No

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9. Proposed Schedule of Installation of : May - 2008

Plant & Machinery10. Type of Organisation : Hindu Undivided Family

11. (a) Main Manufacturing/Service ActivityNo Service ServiceCode1 CRANK SHAFT GRINDING 96808

12. Proposed Investment In Fixed Assets (Rs in lakh) Item Owned/Leased/Rented Approximate Value

(i). Land Owned 1000(ii). Building Owned 1000(iii). Plant & Machinery Value 0(iv). Equipment 15(v). Foreign Equity,If Any -

13. Installed Capacity per annum : 0

14. Power Load (Anticipated) : H.P : 1.50 K.W : -15. (a). Other Source of Energy

Item QuantityElectricity From Grid 2 KWhElectricity From Generator 2 KWh

(b) Reason if no power required -16. Expected Employment

(i). Management & Office Staff 2(ii). Supervisory 2(iii). Workers 2

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17. Expected Schedule Of Commencement of Production/Activity : May- 2022

18. Entrepreneurs Profile(a). Name : S SIVARAJ S/O SUBRAMANI(b). Gender : Male (M) (c). Community : OBC (3)(d). Knowledge Level : Under Graduate(e). Equity Participation : 1000 (f). Equity % : 10(g). Stake in other Manufacturing Enterprises : No(h). Physically Challenged: No

Date :Place :

[SIGNATURE OF THE APPLICANT / AUTHORISED PERSON]

NAME OF THE PROPRIETOR/PARTNER/MANAGING DIRECTOR

(a) Send a self-certified copy of this application along with a self-certified copy of Power of Attorney/Board Resolution/Society Resolution whereverapplicable, while signing as Partner/Managing Director or Authorised Person to GENERAL MANAGER , DISTRICT INDUSTRIES CENTRE, SIDCOIE, SALEM MAIN ROAD, DHARMAPURI-636701.(b) Send a certificate/notarized copy of the Partnership Deed/Memorandum of association/Articles of Association to General Manager, DistrictIndustries Centre, Dharmapuri .(c) In case, self certified copy of the generated application is not received by the General Manager, District Industries Centre, Dharmapuri withinone month from the date of generation of the application, the acknowledgement issued for EM(PART I)will be cancelled and displayed in thewebsite.(d) In respect of those who furnish wrong information and do manipulations in the online Application Form, penal action will be taken by the Department and simultaneously the acknowledgement issued for online EM PART I will be automatically cancelled and displayed in the website.

Undertaking This is to certify that the information furnished in the Memorandum in FORM No :2015/33/005/11199/SARK is true andcorrect to the best of my knowledge and belief.

Date :Place :

[SIGNATURE OF THE APPLICANT / AUTHORISED PERSON]

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