KERALA STATE INDUSTRIAL DEVELOPMENT

CORPORATION LTD.

Application for allotment of Land at 
Bio360 Life Sciences Parks, Thonnakkal, Thiruvananthapuram

FORM - A

REGISTRATION FOR ALLOTMENT

	……………………………………………………………………………………	
A.	APPLICANT	:	
1.	Name of the applicant	:	
2.	Full postal address of the	:	
	applicant with Phone no, Fax,		
	E mail, Website etc		
3.	Name of the entity in whose	:	
	name the land area is		
	to be allotted and whether the entity has been registered?		
4.	  Type of project proposed to be	:	
	set up		

5.	Whether the applicant is	:	
	already engaged in the		
	manufacture of the same		
	product?		
6.	Whether the land area	:	
	required is to set up a new		
	project or to relocate an		
	existing unit ?		
			
B.	CHIEF PROMOTER	:	
1.	Name	:	

2.	Permanent residential address : with phone/mobile /email numbers

3.	 Age	:	
4.	 Educational Qualifications	:	
5.	Experience in	:	
	trading/manufacturing		
	activities		

6.	Details of liabilities to Financial Institution, if any?

:

7.	Name & address of the banks with which the chief promoter has accounts/ transactions

:

8.	Whether Income Tax Assessee?              : 
(enclose copy of returns filed)

C   OTHER PROMOTERS	:		
1   Name & address of other	:	1	
     promoters associated with the			
     proposed project			

  : 2

  : 3

D	EXISTING CONCERNS OF	:	
	THE PROMOTER(s), IF ANY?

Name of the chief Promoter(s)	Name of the Concern	Address	Location of the factory	Date of commencing commercial operation	Whether  loan assistance from any financial Institutions/banks	Products	

E.	PROPOSED PROJECT	:	
1.	Products proposed for	:	
	manufacture with installed		
	capacity		
2.	Cost of Project	:	
3.	Whether any loan assistance is	:	
	envisaged for setting up the		
	project?		
4.	Whether the project is export	:	
	oriented?		
5.	Power requirement ( KVA)	:	
6.	Water Requirement ( KL/day)	:	
	 		
7.	Whether the process of	:	
	manufacture involves any		
	pollution?		
8	Manpower requirement	:	
9.	Minimum Land area	:	
	required for the project  		
	(acre/sq.ft)		

10.	Implementation period	:	
	envisaged  ( months)		
11.	Proposed date of commencing	:	
	commercial operation		

F.	ENCLOSURES(If not submitted)

	1.	Project report			
	2.	Copy of Income Tax returns of the chief promoter(s)			
	3.	Copies of audited balance sheet and profit and loss account of the existing concerns of the promoters for the last three years

Place:                                                                                                             Name
Date:                                                                    Signature of the Chief Promoter