Registration of Plastics Units

Application Form

GENERAL INFORMATION(Part-1)

Applicant Name:*

Designation:

Address Of Applicant :

Street/Road Name/City:

Post Office:*

District:*

Pin Code:*

Telephone:

Date Of Application:*

(DD/MM/YYYY)

GENERAL INFORMATION(Part-2)

Unit Name:*

Municipal Authority:*

Location Of Activity

Ward Number:

Police Station:*

Post Office:*

Local Body:

Plot Number:

District:*

Pin Code:*

Telephone No.:

Fax Number:

Address Of Unit

Ward Number:

Police Station:*

Post Office:*

Local Body:

Plot Number:

District:*

Pin Code:*

Telephone No.:

Fax Number:

Registration Required For
Manufacturing

Carry Bag Virgin:*

Carry Bag Recycled:*

Manufacturing Capacity:
(MT/Month)

Containers Virgin:*

Container Recycled:*

Manufacturing Capacity:
(MT/Month)

Whether Renewal of Registration:*

Previous Registration Number (if yes):

Previous Registration Date (if yes):

(DD/MM/YYYY)

Whether Registered Under DCSSI/
Dept. Of Industries Under State
Govt./Union Territory:
Administration*

Copy Of Registration Certificate Attached (if yes):*

Total Investment:
((Plant+Machinery+Land+Building)
-Cost For Pollution Control System)*

Year Of Commencement:*

Details Of Product

Details Of By-products

Name	Quantity(Average)	Quantity(Unit)