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FORM-IV

APPLICATION FORM FOR ASSISTANCE FOR PUBLICITY

Name of the SSI unit with full address and e-mail ID (if any).
SSI registration number indicating place of issue (copy of registration certificate is to be enclosed)
Membership number of FIEO/EPC (enclose proof of membership)
Value of exports during last 3 years at FOB (CA's certificate to be enclosed)
Title of publicity material proposed to be published (Dummy copy to be enclosed)
Name and details of the event where publicity material is proposed to be distributed
Anticipated date of release
Number of copies of the publicity material to be printed (enclose detailed quotations from printers for production)
Total estimated expenditure
Whether the SSI unit has been charged/ prosecuted/debarred/blacklisted/under investigation under Exim Policy or any other law relating to export import business
Whether any MDA assistance has been availed from any source for similar activity in this financial year


Date:
Signature Name & Designation
Encl: