(Fields marked with an * (asterisk) are mandatory)

APPLICANT'S INFORMATION

APPLICANT'S PROFILE

TYPE OF ENTITY/BUSINESS CONCERN (Please tick as appropriate)

NTN / Registration

NOMINEE INFORMATION (if any)

SELECT ECONOMIC ZONE*

DESCRIPTION OF INDUSTRY

INDUSTRY TYPE (Main type / Sub type): *

DETAILS OF PROPOSED PROJECT

DESIRED PLOT SIZE

Acres

Acres

TOTAL PROJECT COST IN MILLIONS (Excluding land cost)

ESTIMATED NUMBER OF EMPLOYEES

ESTIMATED DEMAND OF UTILITIES

MODE OF FINANCING

ESTIMATED COST OF PROJECT (In Millions)