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Application for State/ District Awards to Small Scale Entrepreneurs – 2018
Award Category

Basic Details:

Name of Entrepreneur
Address of Entrepreneur where communication is to be sent (Telephone & Address)
Name & Address of MSME Unit
Whether the Entrepreneur belongs to SC/ ST/ OBC
Educational Qualification
Experience(Technical Managerial Training etc.)
Permanent SSI Registration No.
Permanent SSI Registration Date

Permanent SSI Certificate
Details of Product manufactured by Unit
Investment Details:

Details 2015-16 2016-17 2017-18
Plant & Machinery
Other Fixed Assets (Land & Building)
Working Capital
Total investments
Own Investments
Borrowed from other sources including banks
Production Details:

Details 2015-16 2016-17 2017-18
Annual Production
Sales Turnover
Profit before Taxation
Profit after Taxation
Income Tax Paid
Financial Management:

Details 2015-16 2016-17 2017-18
Audited Statement
Earnings Adjusted Towards
Long Term Debt
Whether any award has been received by Entrepreneur in connection with Industry promoted by him/her, if so, details may be given
Please give a brief writeup- not more than 300 words about yourself, your unit and products manufactured/ service render by you indicating your achievement to justify as to why your application be considered for the award
Enclosures Upload: