FORM - FC/IL

SIA

COMPOSITE FORM FOR FOREIGN COLLABORATION

AND INDUSTRIAL LICENCE

Please fill up the attached supplementary sheets

Part A: For only FC / Part B: For only IL / Both Part A and Part B for FC+IL

GENERAL INFORMATION

1. Type of Application (Please Ö the Appropriate Boxes)

a. Foreign Collaboration (FC)

For Foreign Investment For Foreign Technology Agreements

b. Industrial Licence (IL)

2.

(For Office Use Only)

Application No.

Application Date

3. Payment Details (For FC Application No Fee is Payable. For Industrial Licences Rs.

2500, * is Payable)

Draft No. ___________________________________

Amount (Rs.)

Draft Date

Drawn on ____________________ Payable at _________________

(Name of the Bank)

__________________________________________________________________________

*Demand Draft should be made in favour of Pay & Accounts Officer, Deptt. of Industrial Development, to be payable at State Bank of India, Nirman Bhawan Branch, New Delhi

I. Name and Address of the Promoter / Industrial Undertaking (Indian/foreign) in full (BLOCK LETTERS) for Correspondence.

Name of the Promoter/Indl.

Undertaking

Postal Address

Pin Code

Telephone

Telex

Fax

Cable

E-Mail

II. Registrar of Companies Regisration No.

(If Registered)

III. Status of the Promoter/Industrial Undertaking

III (1) Status of the Promoter / Promoter Undertaking

1. Central Government Undertaking 5. Joint Sector Undertaking

2. State Government Undertaking 6. Private Sector Undertaking

3. State Industrial Government Corpn. 7. Individual Promoter

4. Co-operative Undertaking 8. Foreign/NRI/OCB Company

9. Foreign/NRI Individual

III (2) Indicate whether this proposal is for (Please Ö the Appropriate Box)

1. Establisnment of New Undertaking / Setting up a New Company

2. Effecting Substantial Expansion

3 Manufacture of New Articles

4. Amendments in existing Foreign Collaboration APproval

5. Inducting Foreign / NRI equity in existing Indian Company

IV(1) Location of the Factory/Proposed Activities

Address

District

State

Pin Code Telephone

Fax

E-Mail

IV(2) Please Indicate whether the proposed location is

(Please Ö the Appropriate Box)

a. Within 25 kms from the periphery of a city having population above one million according to 1991 census

Yes No

b If Yes , then whether it is located in an Industrial area / Industrial estate Designated / set up prior to 25.7.91

Yes No

V(A). EXISTING ACTIVITIES OF THE COMPANY(Here also specify Item codes as per National Industrial Classification of All Economic Activity, (NIC), 1987.

V(B). PROPOSED ACTIVITIES OF THE COMPANY

(1) Items of manufacture (including By-product/Co-product) proposed to be undertaken (supplementary sheets may be used if necessary).

(a) Item code (NATIONAL INDUSTRIAL CLASSIFICATION OF ALL ECONOMIC ACTIVITY (NIC), 1987)

(b)	Item Description

(c) Proposed Annual Capacity

(d) Existing Capacity

(If, applicable)*

(e) Total Capacity after

expansion

(f) Unit of capacity

(g) Description of Activities to be undertaken(if no manufacturing is envisaged)

(2) Whether the Item is covered in Schedule I (Reserved for Public Sector), Schedule II (Under Compulsory Licensing) or Schedule III (Reserved for manufacture in the Small Scale Sector) of the Notification No. 477 (E) Dated 25th July, 1991

Schedule I Schedule II Schedule III

Yes Yes Yes

No. No. No.

(3) Briefly indicate process involved in manufacture of the items(s)

V(C) Attach list of Industrial Licence/Registration/LOI/IEM acknowledgements already issued in favour of the applicant so far.

V(D) Whether the Indian Promoter/Company has had a foreign collaboration earlier? If yes, please specify whether for the same or similar or different products/activity. Please also indicate the Approving Authority and date & No. of the Approval Letter.

(E) Whether the foreign /NRI/OCB collaborator has collaborations with any other Individual/Company in India for the same or similar or different products/activities? If so,please furnish / details.

___________________________________________________________________ Particulars of approval/Industrial Licence under which existing capacity is indicated may be annexed

VI CAPITAL STRUCTURE

(I) Capital Structure of Existing Indian Company(Amount in Rupees) & proposed capital structure (if revision sought)

Equity Preference

(a)	Authorised

(b)	Subscribed

(c)

Paid-up

(II) Pattern of share holding in Paid-up Capital (Amount in Rupees)

Existing Proposed

Equity % Equity %

(a)	Foreign Holding

Preference share Percentage

(b) Non resident Indian Individual holding/OCB holding

Equity % Equity %

(i)	Repatriable

Preference share Percentage

Equity % Equity %

(ii)	Non-Repatriable

Preference share Percentage

Equity % Equity %

(c)	Resident Holding

Preference share Percentage

(d) Total II [a+b(i+ii)+c]:

Equity

Preference

VII Proposed Borrowings (In Rupees)

(i) Public Financial Institution

(ii) Public Borrowing

(iii) Other Sources

(iv) ECB

(v) Promoter Contributions

Total Borrowings

VIII. Please Indicate in brief:

(i) The background of the Indian Promotors/Company including Proprietors /

Promotor/Directors (attach seperate sheet, if necessary)

(ii) The background of the Foreign/NRI/OCB Collaborator/Promoter (attach

seperate sheet, if necessary)

IX. Investment (in Rupees)

Existing Proposed

(A) Land

(B) Building

(C) Plant &

Machinery

(i) Indigenous

(ii) Imported

(a) CIF Value

(b) Landed Cost

(iii) Total

[(i)+(ii)(b)]

(D) Working

Capital

(E) Total

Investment

[A+B+C(iii)]

X. Export commitments / obligation which the applicant is prepared to undertake.

Item Code

______________________________________________________________________ Year Units(Tonnes/ number Quantity % age of FOB Value

/meters/ any other) Production in Rupees

(1) (2) (3) (4) (5)

1st

2nd

3rd

4th

5th etc

_____________________________________________________________________

Total

____________________________________________________________________

Please Indicate buy back arrangements, if any

XI. Employment (All Figures in Numbers)

Existing Proposed Total

(If applicable)