F O R M - A
DIRECTORATE GENERAL OF
SUPPLIES & DISPOSALS
(QUALITY ASSURANCE
WING)
Application form for registration of
firms for indigenous
stores as manufacturers/assemblers/converters
(To be submitted in
duplicate)
1. Category under which registra- a) Manufacturer
tion is sought (tick as appropriate) b) Assembler
c)
Converter
2. Name of Applicant firm:
Address/telephone/fax/e-mail no.of
a) Regd.
office:
b) Head Office:
c) Other offices:
3.
Status of applicant firm
a) Date of Incorporation:
b) Date of commencement of business:
c) Constitution of the firm:
i) Proprietorship / Partnership
(attach copy of Partnership deed and
Form-A
or equivalent entry
certificate
from Registrar of Firms
duly notarised)
ii) Public Limited/Pvt.Limited/
Industrial Cooperative
(Attach
Memorandum/Article of
Association
and copy of
signed
certificate of incorporation duly
notarised)
c) Names,
addresses and telephone
nos.of Proprietor/Partners/Directors
having interest in the firm:
d) If the firm is a subsidiary of an
Indian/foreign company, give
particulars of parent/holding
company?
e) If there are other susidiaries of
the same parent company in
give full particulars.
f) If the Directors/ Partners/
Proprietor have financial interests
or are represented on Board(s)
of
other companies give details .
g)
Income-tax Circle/Ward/District
in which the Applicant firm
is
assessed to
Income-tax. (Please
indicate GIR/PAN No.)
h) Sales Tax registration no(s).
4.Stores for which registetion is required.
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Sl No
Brief Ref. of IS Model
Limiting Annual
Description Specification /Brand
size/ production
capacity/ capacity
rating per shift
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(1)
(2) (3) (4) (5) (6)
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5.
Details of factory/godown
a) Address & Tel.No.
(Attach copy of ownership documents
or if on lease, attach copy of lease
agreement valid for at least
three
years; duly notarised)
b)
Description of factory/ godown
giving
covered/ uncovered area,
departments, and laboratories etc.
6.
Detail of stocks held
a) Raw materials
b) Finished goods
7. Technical
facilities
a) Details of plant
and machinery
installed.
b) Full information of the technical
knowhow of products with flow chart.
c) Quality control arrangements for
routine and acceptance tests.
d)
Details of testing machinery &
facilities
8.
Details of personnel employed:
technical/skilled/others
9. State
if the products have been
fully tested, including type
tests
where
required in specfications.If
so attach copy of test reports.
10.If
the products require
after
sales
service, give names
&
addresses
of places where
such
facilities
are available and
indicate
value/ extent of
spare
parts maintained and staff employed.
11.
Indicate if your products are
directly marketed by you in whole of
firms
with whom marketing
arrangements have
been made
productwise/areawise.
12.
Whether registered with DGS&D
and/or NSIC or any other Government
organisation? If
so, furnish
copy(ies)
of such registration
letters.
13.
Whether the unit
is
SSI/non-SSI? If
SSI, furnish copy
of permanent SSI Certificate. If
non-SSI,
furnish copy of
acknowledgement of the
memorandum
submitted
to SIA of
Ministry of
Industries.
14.
Details of past supplies made
for the
items for which
registra
tion
has been sought in proforma as
in Annexure-4.
15.
Annual turnover for last three
years
(yearwise) duly supported by
relevant Balance Sheet .
16.
Name and address
of the
bankers:
(Indicate Account No.
with each
bank and submit Bankers
report in
original
as per proforma
in
17. Additional/Optional information:
a)
State if the
products are BIS
marked.
If so attach
a copy of
valid BIS license.
b)
State if the firm have ISO 9000
certification. If yes, attach
copy of the same.
18.
Name and designation
of the
signatory
of this application
(enclose a copy of power of attorney
where
applicable)
Place:
Authorised signatory(ies)
Date:
with seal
Notes:
1.
If the firm
is seeking registration
for more than
one
manufacturing unit, separate application with requisite fee
should be
submitted for each.
2.
All
Annexures/Enclosures/documents,
supporting the application
should be authenticated under signatures of
the applicant in ink with
seal of the firm.
3.
This form is to be accompanied by the statements/ declaration etc
as in
Annexures 1, 2, 3B, 4
& 6. The applicants must also complete
the checklist as given
below to ensure
that the application
is
complete
in all respects.The applications with
incomplete
infomation/documents are liable to be
rejected.
Check list:
1. Application
form fee coupon of Rs.100/- or
Indian Postal Order
for Rs.100/- payable to DGS&D,
fee
alongwith processing fee Rs.5000/-
+ Service Tax & Educational Cess
as applicable(presently @12.36%)
for non SSI unit, Rs.3500/-
+ Service
Tax & Educational Cess as
applicable(presently @12.36%)for SSI unit
irrespective of category of
registration, in form of Demand
Draft payable to DGS&D,
tion charges will be leviable.(No
application form-fee charges will be
applicable if the application form is
downloaded from the website)
2.
Notarised copy of permanent SSI
Certificate for SSI Unit or copy
of acknowledgement of the Memorandum
submitted to SIA of Ministry of
Industry for non-SSI Unit.
a) Copy of Pollution Control Certificate.
b) Copy of Excise Duty Registration
Certificate.
3.
Affidavit as per Annexure-3B duly notarised.
4.
Statement of Profit
& Loss and Balancesheet for the last three
years.
5.
Notarised copy of
General Power of Attorney in favour of the
person signing the application as authorised
signatory.
6.
Performance statement as per Proforma
Annexure-4 of
the
application.
7.
Notarised copy of ownership
documents of the premises or copy of
lease deed (valid for a minimum period of
three year).
8.
Bankers' Report giving
details of financial
status of the
applicant firm as per proforma Annexure-6.
9. a)
List of Plant & Machinery installed.
b) List of technical personnel employed in production
and services.
c) Item for which registration required with
detailed specification.
d)
Write-up on quality
control measurement adopted by the firm for
ensuring quality of rawmaterial brought out
item for assembly
and
subassembly and in process and finished
products quality control.
e) List of quality control equipment and
testing facility available in
factory.
f) Copy of type test report from Independent
lab. where applicable as
mentioned in relevant standard.
10.
Documentary proof of the status of the firm:
a) For
the Limited Companies/Industrial Cooperatives.
i) Copy of Memorandum and Articles of
Association duly notarised.
ii) Signed copy of Certificate of
Incorporation authenticated
by Notary public.
b) Partnership firms.
i) Copy of Partnership deed duly
authenticated by notary public.
ii)Power of Attorney in respect of partner,
if any duly notarised.
iii)Certified copy of Entry Form-A or
equivalent from the Registrar of
firm, duly notarised.
11.
Two copies of
declaration signed by
the vendor accepting
condition of registration as per Annexure 1
& 2.
12. List of rawmaterials and
finished goods in stock.
13.
Copy of BIS licence if applicable.
14.
Copy of ISO 9000 (Optional).
15.
Copy of Registration
Certificate if registered
with any
NSIC/other Govt. organisation.
16.
List of places
where after sales
service faclities (if
applicable) are available.
(form99)