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Online Filing of Entrepreneurs Memorandum Form Download ADOBE
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1. Name of The Applicant *
 
2.(a) Address Of Communication * (ii) Fax Number
(iii) Cell Phone Number *
(iv) E-Mail
PIN Code * (v) Web-Site
(i) Telephone Number (with STD code)    
 
(b) Permanent Resdential Address          (Main Applicant) * (ii) Fax Number
(iii) Cell Phone Number
(iv) E-Mail
PIN Code * (v) Web-Site
(i) Telephone Number (with STD code)    
 
3.Name Of The Proposed Enterprise   (If Decided) *
 
4.Proposed Location of Enterprise
S.F.No. / Door No.*
Street Name *
(i) Area Rural Urban
(ii) State
(iii) District*
(iv) Taluk *
(v) Block *
(vi) Village/Town *
(vii) PIN Code *
 
5.Category Of Enterprise * Micro Small Medium
 
6.Nature Of Activity* Manufacture Service
 
7.Nature Of Operation* Perennial Seasonal Casual
 
 
8.Whether The Unit Will Be An Ancillary * Yes No
 
9.Proposed Schedule Of Installation Of Plant And Machinery
 
10.Type Of Organisation *
Proprietary Hindu Undivided Family
Partnership Private Limited Company
Public Limited Company Selfhelp Groups
Others
11.(a) Main Manufacturing /Service Activity
Main Activity*
Sub Activity (Level-I) *
Sub Activity (Level-II)  *
Sub Activity (Level-III)  *
(b) Products To Be Manufactured /Service To Be Provided
Note: For Those activities that does not appear in this list, nearest District Industries Centre may be contacted to get acknowledgement of EM Part I registration through manual procedure.
Activity List Qty Unit
Item Activity Quantity Unit
12.(a) Proposed Investment In Fixed Assets [Rupees In Lakh]
i) Land * Owned Rented Leased Approximate Value
(ii) Building* Owned Rented Leased Approximate Value
(iii) Plant And machinery (In case of manufacturing enterprise ) * Approximate value
(iv) Equipment (In case of service enterprise) Value
(v) Foreign Equity, If Any Value
13. Installed Capacity (Proposed) per Annum
Quantity Unit
 
14.Power Load (Anticipated) *
H.P K.W
 
15.(a) Other Source Of Energy/Power (If Required)
Source of Energy Yes/No Quantity Unit
Coal
Oil 
Liquid Petroleum Gas
Electricity From Grid 
 Electricity From Generator 
Non-Conventional Energy
Traditional Energy  
Firewood 
 b) If no power required specify reasons
 
16.Expected Employment *
(i) Management And Office Staff (ii) Supervisory (iii) Workers
17.Expected Schedule Of Commencement Of Production/Acitviy *
 
18.Enterpreneurs Profile: *
Name
Gender * Community *

Knowledge Level *
Equity Participation (in Rs)  *     Equity %   Physically Challenged Yes No
Stake In Other Manufacturing Enterprises Yes No
Name Gender Community Knowledge Equity (Rs) Equity(%) Stake (Y/N) Phy.Challenged (Y/N)