|
Annexure
- VII
Application
Form For Marketing Development Assistance
For Production of Publicity Material
Ref
No.---------
Date : ---------
| 01 |
Name of the firm
with full address |
IEC No-------
|
| 02 |
Approval letter
No. and date |
|
| 03 |
EH / TH
Certificate No. & Date |
No & Date ---------
Valid Upto ---------
|
| 04 |
Whether SSI ?
|
Yes / No.
(if yes, attach a a self-certified copy of SSI
Registration Certificate) |
| 05 |
Details of the
event where the publicity material was used.
|
(Please
attach a self certified copy of the publication used.)
|
| 06 |
No. of Copies of
publicity material prepared.
|
|
| 07 |
Payment particulars |
Amount Paid
---------------
(Please attach self certified photocopies
of the quotations received and of the receipt / bank advice
etc.evidencing payment made.) |
| 08 |
Whether
assistance received from other Government bodies / EPC / Commodity
Board / APEDA / MPEDA / ITPO etc. for the activity under reference
|
Yes / No
(If yes, please
give full details) |
| 09 |
Amount Claimed
|
Rs.------------------ |
Declaration
I solemnly
declare that the particulars given in the above statement are correct. I
bound myself and the company accountable and responsible for any incorrect
information given in the above statement and shall immediately refund
amount received on the basis of wrong information provided in the above
statement.
Signature
------------------
Name -----------------------
Designation
--------------
Office Seal : ---------------
Place :
Date
:
| 