APPLICATION FORMAT

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1.   NAME AND COMMUNICATION DETAILS

1.1          Full legal name / structure of applicant                          :

1.2          Registered Office Address                               :

1.3          (i)    Telephone                                                                    :

                (ii)   Fax                                                                                 :

               (iii)  Mail ID                                                                            :

1.4     Name and address of authorised person and

          Mobile No.                                                                                  :

1.5     Correspondence Address of applicant:                                :

2.       NATURE/STATUS OF APPLICANT  (Whether sole proprietary /Partnership/Private Ltd./ Public Limited/Public Sector/Society/Co-operative Society)

             (i)     Copy of Registration certificate of applicant.            :

       (ii)     Memorandum of articles of Association in case of company :

      (iii)     Partnership deed, in case of firm

           (iv)     Copy of Bye  Laws of  Society /

                     Co-operative Society  alongwith

                     list of Members                                                               :

(v)      In case of individual declaration on stamp paper of Rs. 5/- only, duly notatarised, to the effect that he is applying for the project as a sole proprietary.                                                                      :

3     Category of Applicant:-

i)        Belonging to Panchayat of the Project area                   :              Yes  /No.

         (Proof to be attached)

ii)       Belonging to the  District  of the Project area                :               Yes / No.

         (Proof to be attached)

iii)       Himachali                                                                       :              Yes/ No.

        (Proof  to be attached)

(In case of the share holders in the entity happen to be of Local Panchayat, Local District and Other Himachali, the applying applicant should specifically, mention this effect  in the application with proof thereof.)

4      Details of the project site

         i)             Project Name                                                                  :

     ii)         Capacity                                                                           :

      iii)        Code (write Sr. No. of the project in the list of identified Project. In case of Self Identified     project, the applicant should write the word  Self Identified).                                                                                                        :

iv)         Location:

          Co ordinates:

                     Weir Site:

                     Power House / Tail Race:

v)             Elevations ( w.r.t. SOI or any other

             established reference mark. indicate

             reference mark)                                                             :

             a)  Weir Site                                                                    :                           

             b)   Power house/Tailrace                                           :

 vi)      Stream / Sub Tributary/ Tributary                               :

 vii)     Basin                                                                                :

viii)    District                                                                              :

5          Has the site of the project

applied for been visited by you ?                                                    :                        Yes  / No

Photographs of site (Weir Sit/Power House/Tail Race)

   6.   Have the applicant /share holders in the company been  allotted projects in the past ?

          (individually or as share holders in other companies )  

If Yes; 

(i)       Name of the project allotted                      :

(ii)     Stream/Sub tributary/Tributary/ Basin     :

(iii)    Name of the company where they were share holders

(iv) Status of the projects

a)       Commissioned                                                             :

     b)    Under execution                                                                          :

7.1    FINANCIAL DETAILS OF APPLICANT

(i)           Net Worth of the applicant  in Rupees                  :

(ii)        In case newly formed company/ Firms /Society /Co-operative Society,  Net worth of  each share holder of that entity:

(Proof of Net Worth and the documents on the basis of which net worth has been worked out should be attached with application

7.2          Detail of share holders of the applicant:

      (i)    Name and address

            (ii)  Number of Shares/Percentage of shares.                                           

7.3          In case the applicant has applied for more than  one project, percentage(%age) of Net Worth to be considered against each project should be clearly mentioned:

7.4          Details of proposal to finance the project (In case project is allotted to you)

8.             LIST OF INDUSTRIES IN HIMACHAL PRADESH (either owned by the IPP or a third party, where the IPP may like to use the power generated from the project):

                  If yes, energy requirements                                       :

9.             ANY OTHER INFORMATION                                 :  

Note:-       No. Solvency Certificate from any bank shall be considered. Fixed deposit /cash balance in bank   should be  duly  certified by the concerned Bank with proof thereof for Net Worth evaluation.

 Date :                                                                                                       (Name, Designation/Title of   

Place:                                                                                               Person Signing) With Seal