CLAIM FORM FOR FINANCIAL ASSISTANCE FOR
PUBLICITY ABROAD
| 1. | Name of the SSI unit with full address and e-mail ID (if any) | ____________________ | |
| 2. | In principal approval letter number and date | ____________________ | |
| 3. | Details of the event where publicity material was released, alongwith dates (Actual copy of publicity material to be enclosed) | ____________________ | |
| 4. | No. of copies of publicity material prepared | ____________________ | |
| 5. | Total expenditure incurred (Attach copy of payment voucher/receipt) | ____________________ | |
| 6. | Total amount claimed | ____________________ | |
| 7. | Whether the SSI unit has been charged/prosecuted/debarred/blacklisted/under investigation under Exim Policy or any other law relating to export import business | ____________________ | |
| 8. | Whether any MDA assistance has been availed from any source for similar activity in this financial year | ____________________ | |
| Declaration : | |||
| I declare that the particulars given in the above statement are correct. I also undertake that any financial assistance granted to me/my unit on the basis of this declaration shall be liable to be refunded to the Government if at any time any information furnished in this application is found to be wrong or incorrect or misleading and I do hereby bind myself and my unit to pay the Government on demand, a sum equal to the amount claimed as SSI-MDA in respect of above mentioned activity, within seven days of the demand being made to me in writing. | |||
| Date : | Signature | ||
| Name & Designation | |||
| Encl.: |
