Form No :      
 
(To be filled up and submitted to the District Industries Centre after commencement of production/activity[ The rows which have been repeated need to be filled only to the extent that actual details on commencement vary from those in Part I ])
ENTREPRENEURS MEMORANDUM NUMBER(Part I)
DATE OF ISSUE
MONTH OF COMMENCEMENT OF PRODUCTION/ ACTIVITY (MM/YYYY)  
 
 
PERSONAL DETAILS
   
     
 
 
 
     
 
 
 
 
 
NAME AND LOCATION OF ENTERPRISE
 
     
 
 
 
 
 
 
 
 
 
CATEGORY AND ACTIVITY OF ENTERPRISE
Manufacture Service
 
 
PRODUCT DETAILS OF ENTERPRISE
MAIN MANUFACTURING / SERVICE ACTIVITY  
 
PRODUCTS MANUFACTURED/SERVICE AND PROVIDED  
 
 
Approx. Value  
Approx. Value  
 
 
 
 
  PRODUCT QTY/Year UNIT
1.
   
H.P K.W
   
   
     
  
 
 
 
EMPLOYMENT
  MALE(No.) FEMALE(No.) TOTAL(No.)  
  MANAGEMENT AND OFFICE STAFF  
  SUPERVISORY  
  WORKERS  
 
 
 
 
ENTREPRENEURS' PROFILE
20.
ENTREPRENEURS' PROFILE (OF ALL PARTNERS/DIRECTORS OF THE ORGANISATION )
   
NAME GENDER CATEGORY KNOWLEDGE LEVEL EQUITY PARTICIPATION (%) STAKE IN OTHER ENTERPRISES
MF
21.
     
 
 
  Date  
  Place  
This is to certify that the information furnished in the memorandum is true and correct to the best of my knowledge and belief. I / We have obtained approval / consent / license / permit from the concerned Ministry / Department of Central Government / State Government / UT Administration as per statutory requirements.