Name of the Company *
Address for Correspondence with Telephone, Fax, Email & Website *
Factory Address *
Year of Establishment *
Name of the Chief Executive with brief Bio-Data & Mobile No *
Total Project Cost *
No of Employees * DirectIndirect
Accreditation CGMPCOSMCATGAUSFDA
Date of Approval
For Plant *
For Product *
Name of the ProductsCGMPCOSMCATGAUSFDA
Installed Capacity
Qty.
Val.
Year
Intermediates
API's
Formulations (In Rupees)
D.D. / Chq. No
Date
Name of the Bank
Amount
Company Seal
Signature
Name of the Proposer
Designation
Name of the Company
Membership No.
Signature of Proposer
Date of Receipt of Application
Scrutinised By
Accepted IN E.C.
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