Date of Application (format: dd/MM/yyyy)	:
For submission to CLE office	:	Select One CLE - Agra CLE - Chennai CLE - Kanpur CLE - Kolkata CLE - Mumbai CLE - New Delhi
Form: IDLS-I Application Form for Assistance under INTEGRATED DEVELOPMENT OF LEATHER SECTOR (IDLS) SCHEME (Hard copy to be submitted in Triplicate)
1. Name of the Firm/Company	:
2. PAN Number	:
3. Name of sole proprietor/ partners/directors	:
4. Office Address       (Full address)	:
City	:
Phone	:
FAX	:
E-Mail	:
5. Factory Address	:
Phone	:
FAX	:
E-Mail	:
6.Date of incorporation/ commencement of production	:
7.Item of manufacture for which modernization proposal is submitted
7(a) Type of Industry	:	Select One Tannery Footwear Component Footwear Leather Goods Leather Garments Composites Others (specify)
7(b) Category of the unit SSI/Non-SSI	:	SSI           Non SSI
8(a) Existing capacity	:
8(b) Capacity proposed/ achieved after modernization	:

9.Past performance (for three years on the basis of audited balance sheets)
9(a) Financial position     Financial year (Y-1) Financial year (Y-2) Financial year (Y-3) I Net block II Current assets III Current liabilities IV Term Loan V Share Capital VI Reserve and surplus  (less accumulated losses) VII Net worth – (V+VI)
9(b) Working result     Financial year (Y-1) Financial year (Y-2) Financial year (Y-3) I Total sales II Gross Profit (before interest and depreciation) III Depreciation IV Interest V Operating profit VI Net Profit (after tax)
10. (a) Details of machines covered under the scheme
(In case of imported machines the cost should be given in foreign currency and rupee equivalent). (A separate annexure may be given)
Sl.No. Make, Description & Specification of machines Quantity Unit cost (as per quotation / supply proforma invoice) Source of supply Total cost
10(b) In case, machines have been procured already, then date of sanction of loan/Date of order for machines in case of self financing
10(c) Estimated Sales and excise tax	:
10(d) Estimated cost of freight and transportation and insurance	:
10(e) Estimated custom duty	:
Total (c)+(d)+(e)	:
11. Total cost of scheme (as approved by Bank/FIs)	:
12. Total sources of funding (as approved by Banks/FIs)	:
Term loan	:
Add share capital	:
Internal cost accruals	:
13. Brief Descriptions of the Modernization Initiative and Expected Results: A separate note may be attached relating the Scope of planned work to the objectives of the Scheme.
14. Time frame for completion	:
15. Employment (in man days)
(a) Existing	:
(b) Proposed	:
(c) Total	:
16. Incremental Benefit from the modernization initiative (give quantitative result in the given table)
Particulars Existing Proposed Y-1 Y-2 Y-3 Capacity utilization (%) Increased Sales (Rs) Export growth (US$) Higher productivity (Prs, Pcs, Sq.ft) Employment Generation (Nos) Quality upgradation (% rate of process rejection)
DECLARATION We, hereby declare that the information given above and the statements and other papers enclosed are to the best of our knowledge and belief true and correct Place: Signature: Date:   Name and Designation: