COMMON APPLICATION FORM AND OTHER APPLICATION FORMS

INDEX
Forms Page No.
A. Common Application Form 3
B. Application Forms Prescribed Under Acts and Rules
1 Consent for Establishment of Industry under Water
(Prevention & Control of Pollution) Act, 1974 12
2 Consent for Establishment of Industry under The Air
(Prevention & Control of Pollution) Act, 1981 18
3 Registration & grant of licence under
The Factories Act, 1948 22
4 Approval of Plans & permission to construct / extend /
or take into use any building as a factory under
The Factories Act, 1948 27
5 Approval of site for hazardous process factory
under The Factories Act, 1948 30
6 Registration of Establishment under Contract Labour
(Regulation & Abolition) Act, 1970 34
7 Registration under Chhattisgarh Vanijyik Kar Adhiniyam,94 36
8 Registration under The Central Sales Tax Act, 1956 38
9 Permission for Development of Land under
Chhattisgarh Nagar Tatha Gram Nivesh Adhiniyam, 1973 41
10 Permission to develop, errect, re-erect or to make altration
in any place in a Building under
Chhattisgarh Nagar Tatha Gram Nivesh Adhiniyam, 1973 44
11 Permision for use of Forest Land for Non-Forest
Purposes under Forest (Conservation) Act, 1980 45
C. Application Forms Prescribed by the Administrative Departments -
1 Provisional Registration of Small Scale Industry at
District Trade & Industries Centre 46
2 Allotment of CSIDC Industrial Land 52
3 Allotment of Government Land 57
4 Acquisition of private land 61
5 Exemption from payment of stamp duty by District Trade
& Industries Centre/ Industries Commissnor 65
6 No Objection Certificate by local bodies 67
7 Permission for building construction by Gram Panchayat 68
8 Permission of land diverson 70
9 Sanction of allotment of water by Water Resource Department 71
10 Power availability certificate by CSEB 73
11 Sanction of power supply for L.T. connection by CSEB 75
12 Sanction of power supply for H.T. connection by CSEB 78
13 Approval of drawings by Electrical Inspector 81
14 Environment consent for small scale industry under simplified
procedures by District Trade & Industries Centre 83
15 Registration of boiler under Indian Boiler Act - 1953 85
16 Permanent registration of small scale industry by
District Trade & Industries Centre 90
17 Production certificate for medium & large scale industry
by District Trade & Industries Centre 102
 No. : ...............

Govt. of Chhattisgarh

State Investment Promotion Board

SINGLE WINDOW CLEARANCE

COMMON APPLICATION FORM

&

OTHER APPLICATION FORMS

for Establishment of Industries.

APPLY TO :

For Projects above Rs. 10.00 Cr. For Projects upto Rs. 10.00 Cr.

State Investment Promotion Board District Investment Promotion Committee

Renuka Dwar, Near Mantralaya, Shastry Chowk, C/o District Trade and Industries Centre

RAIPUR - 492001 (Chhattisgarh) District -------------------------------------------------------

Tel. : 0771-5066351,5066352 Tel. -----------------------------------------------------------

Fax : 0771-5066315 Fax -----------------------------------------------------------

 Form - 1

(See Rule - 4 (2))

COMMON APPLICATION FORM

STATE INVESTMENT PROMOTION BOARD - SINGLE WINDOW CLEARANCE

3
 Part – 1- A

INVESTOR’S INFORMATION

1. Investor’s Details ----------------------------------------------------------------------------------------------------

1.1 Name of Investor/Company -------------------------------------------------------------------------------------

1.2 Address of Regd. Office -----------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------

Tel. ----------------------------------------------- Fax ---------------------------------------------------------

Email ---------------------------------------------- Website ---------------------------------------------------

1.3 Name of Chairman/M.D. ------------------------------------------------------------------------------------------

Address -----------------------------------------------------------------------------------------------------------

Tel. ----------------------------------------------- Fax ---------------------------------------------------------

Email ---------------------------------------------- Website ---------------------------------------------------

1.4 Nature of Organization (Please tick)

1. Proprietary 6. Co-operative Society

2. Partnership 7. Public sector

3. Pvt. Ltd. 8. NRI

4. Public Ltd. 9 FDI

5. Joint Sector 10. Others

1.5 For Proprietary only. Do you belong to (Please tick)

1. SC 2. ST 3. OBC 4. Women

STATE INVESTMENT PROMOTION BOARD - SINGLE WINDOW CLEARANCE

4
 Part – 1 – B

PROJECT INFORMATION
2. Project Details
2.1 Name of Unit -------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------
Address for Correspondence ---------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------
Tel.---------------------------- Fax ----------------------------- Email---------------------------------------------
2.2 Nature of Proposed organization (please tick)
1. Proprietary 6. Co-operative Society
2. Partnership 7. Public sector
3. Pvt. Ltd. 8. NRI
4. Public Ltd. 9 FDI
5. Joint Sector 10. Others
2.3 Date of Incorporation of the Company. ------------------------------------------------------------------
2.4 Regd. No. ------------------------------------------------------------------------------------------------------------
2.5 Name of M.D./ Director with complete address &
Tel.---------------------------- Fax ----------------------------- Email---------------------------------------------
(1)----------------------------------------------------------------------------------------------------------------------
(2)----------------------------------------------------------------------------------------------------------------------
(3)----------------------------------------------------------------------------------------------------------------------
2.6 Local Office [contact person] Name ---------------------------------------------------------------------
Address ---------------------------------------------------------------------------------------------------------------
Tel.---------------------------- Fax ----------------------------- Email---------------------------------------------
(1)----------------------------------------------------------------------------------------------------------------------
(2)----------------------------------------------------------------------------------------------------------------------
(3)----------------------------------------------------------------------------------------------------------------------
2.7 Registration for the Project.
(1) FIPB/RBI Approval No. ---------------------- Dt. --------------------- Valid up to ---------------
(2) EOU Registration No. -------------------------- Dt. --------------------- Valid up to ----------------
(3) IEM No. -------------------------------------------- Dt. --------------------- Valid up to ----------------
(4) Prov. SSI Registration No. ------------------- Dt ---------------------- Valid up to ----------------

STATE INVESTMENT PROMOTION BOARD - SINGLE WINDOW CLEARANCE