Form II / SPECIMEN - "B"

SMALL SCALE INDUSTRIES
Application Form for Credit Facilities of over Rs. 2 Lacs & Upto Rs. 15 Lacks)

1.1  Name of the unit
      (In block letters)

1.2  Construction (please strick out      Proprietory/Partnership Firm/Private
      which ever is not applicable)         Limited/Public Limited Company /
                                                     Cooperative Society.

1.3  Name of the business
      house/group (if any)

2.1  (Registration No.
      (as given by the District Industries
       Centre/Directorate of Industries)

2.2  Date of Incorporation/
       Commencement of Business

3. Business Address with Telephone/Telex No.

                    3.1  Registered Office.

                    3.2  Administrative  Office.

                    3.3  Factory

4.  Background of the Proprietor/Partners/Directors
   (Please furnish for each person as  per the Annexure - l)

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