1. Aadhaar Number / आधार संख्या Note :- Mobile Number Must Be Registred With Aadhaar for OTP XXXX Verification

2. Name of Applicant/Entrepreneur / उद्यमी का नाम

3. Social Category / सामाजिक वर्ग Select Option General SC ST OBC

4. Gender / लिंग Select Gender Male Female

5. Physically Handicapped / शारीरिक रूप से विकलांग Select Handicap Status Yes No

6. Name of Enterprise / Business / उद्यम का नाम

7. Type of Organisation / संगठन के प्रकार Select Option Proprietorship Firm Partnership Firm Hindu Undivided Family Co-operative Limited Liability Partnership Private Limited / OPC Public Limited Self Help Group

8. PAN Number / पैन संख्या

9. Location of Plant / संयंत्र के स्थान Flat/Door/Block No. / फ्लैट / द्वार / ब्लॉक सं Name of Premises / Building / Village / परिसर / भवन / गांव का नाम Road / Street / Lane / सड़क / मार्ग / गली City / शहर Pin / पिन State / राज्य Select Andaman and Nicobar Island (UT) Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh (UT) Chhattisgarh Dadra and Nagar Haveli (UT) Daman and Diu (UT) Delhi (NCT) Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep (UT) Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry (UT) Punjab Rajastha Sikkim Tamil Nadu Telangana Tripura Uttarakhand Uttar Pradesh West Bengal District / जिला Please Select

10. Official Address / आधिकारिक पता - SAME AS ABOVE

Address / पता

State / राज्य Select Andaman and Nicobar Island (UT) Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh (UT) Chhattisgarh Dadra and Nagar Haveli (UT) Daman and Diu (UT) Delhi (NCT) Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep (UT) Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry (UT) Punjab Rajastha Sikkim Tamil Nadu Telangana Tripura Uttarakhand Uttar Pradesh West Bengal

District / जिला Please Select

Pin / पिन

11. Mobile Number +91 / मोबाइल नंबर +91-

12. Email / ईमेल

13. Date of commmencement / उद्यम के प्रारंभ की तिथि (DD/MM/YYYY)

14. IFSC Code / आईएफएस कोड

15. Bank Account Number / बैंक खाता संख्या

16. Major Activity of Unit / इकाई का प्रमुख गतिविधि Select Major Activity Manufacturer / विनिर्माण Service Provider / सेवा

17. NIC 2 Digit Code Select 2 Digit NIC Code 01- Crop and animal production, hunting and related service activities 05-Mining and quarring 06-Extraction of crude petroleum and natural gas 07-Mining of metal ores 08-Other mining and quarring 09-Mining support service activities 10-Manufacture of food products 11-Manufacture of beverages 12-Manufacture of tobacco products 13-Manufacture of textiles 14-Manufacture of wearing apparel 15-Manufacture of leather and related products 16-Manufacture of wood and products of wood and cork, except furniture; manufacture of articles of straw and plaiting materials 17-Manufacture of paper and paper products 18-Printing and reproduction of recorded media 19-Manufacture of coke and refined petroleum products 20-Manufacture of chemicals and chemical products 21-Manufacture of pharmaceuticals, medicinal chemical and botanical products 22-Manufacture of rubber and plastics products 23-Manufacture of other non-metallic mineral products 24-Manufacture of basic metals 25-Manufacture of fabricated metal products, except machinery and equipment 26-Manufacture of computer, electronic and optical products 27-Manufacture of electrical equipment 28-Manufacture of machinery and equipment n.e.c. 29-Manufacture of motor vehicles, trailers and semi-trailers 30-Manufacture of other transport equipment 31-Manufacture of furniture 32-Other manufacturing 33-Repair and installation of machinery and equipment 35-Electricity, gas, steam and air conditioning supply 36-Water collection, treatment and supply 37-Sewerage 38-Waste collection, treatment and disposal activities; materials recovery 39-Remediation activities and other waste management services 41-Construction of building 42-Civil Engineering 43-Specialized construction activities Select 2 Digit NIC Code 49-Land transport and transport via pipelines 50-Water transport 51-Air Transport 52-Warehousing and support activities for transportation 53-Postal and courier activities 55-Accommodation 56-Food and beverage service activities 58-Publishing activities 59-Motion picture, video and television programme production, sound recording and music publishing activities 60-Broadcasting and programming activities 61-Telecommunications 62-Computer programming, consultancy and related activities 63-Information service activities 64-Financial service activities, except insurance and pension funding 65-Insurance, reinsurance and pension funding, except compulsory social security 66-Other financial activities 68-Real estate activities 69-Legal and accounting activities 70-Activities of head offices; management consultancy activities 71-Architecture and engineering activities; technical testing and analysis 72-Scientific research and development 73-Advertising and market research 74-Other professional, scientific and technical activities 75-Veterinary activities 77-Rental and leasing activities 78-Employment activities 79-Travel agency, tour operator and other reservation service activities 80-Security and investigation activities 81-Services to buildings and landscape activities 82-Office administrative, office support and other business support activities 84-Public administration and defence; compulsory social security 85-Education 86-Human health activities 87-Residential care activities 88-Social work activities without accommodation 90-Creative, arts and entertainment activities 91-Libraries, archives, museums and other cultural activities 92-Gambling and betting activities 93-Sports activities and amusement and recreation activities 94-Activities of membership organizations 95-Repair of computers and personal and household goods 96-Other personal service activities

18. Additional Details About Business

19. Persons Employed / व्यक्ति नियोजित

20. Investment / निवेश

(Plant & Machinery / Equipment's) (Plant & Machinery / Equipment's) (Rs. In Lakhs)

21. Attachment (jpg,png file < 200KB) Attach scan copy of adhar card or update later : You Can send Documents on 8888291374 Whatsapp Number