1.

GSTIN No.

2.

Legal Name

3.

Trade Name, if an

4.

Central Excise Registration No.

5.

Name of the unit

6.

Address of the unit

7.

State where the unit is located

8.

Date of commencement of commercial production specified goods-wise

1.

2.

3 . . . .

9.

Authorisation issued by the State Government, if an

10.

Erstwhile Central Excise Notification under which exemption was being availed up to 30.06.2017

11.

Residual Period of exemption beyond 30.06.2017 which the unit was entitled for under the erstwhile exemption notification

1.

2.

3 . . . .

12.

Period of budgetary support beyond 30.06.2017 which the unit would be entitled for

13.

Details of specified good(s) for which exemption availed under erstwhile exemption notification

1.

2.

3.....

14.

Bank Account Details for credit of budgetary support

a. Name of the Bank

b. Branch Details

c. Account No.

d. IFSC no. of Branch

15.

Value of clearance and Central Excise duty paid during 2016-17 for each of the specified good(s)

1.

2.

3.

16.

Value of clearance and Central Excise duty paid during 2017-18 (up to 30.06.2017) for each of the specified good (s)

1.

2.

3 . . . .

17.

Any other activity undertaken in the State under the same GSTIN

18.

No of persons employed in the manufacturing unit

19.

EPF no. of the eligible unit/establishment of which the eligible unit is part of

20.

ESIC no. of the eligible unit/establishment of which the eligible unit is part of

21.

Consumption of electricity in units (kwh) during financial year 2016-17 and 2017-18 (up to 30^th June 2017) .