FORM-II

CLAIM FORM FOR PARTICIPATION IN FAIR/STUDY TOUR/

TRADE DELEGATION

1

Name of the SSI unit with full address and e-mail ID (if any).

2

In principal approval letter number and date.

3

Name & designation of person who participated.

4

Details of travel including date of departure from India and arrival in India (copy of passport to be attached)

5

Name of airline by which journey was made and actual expenditure incurred on return airfare (original air ticket to be enclosed)

6

Whether the SSI unit has been charged/ prosecuted/debarred/blacklisted/under investigation under Exim Policy or any other law relating to export import business.

7

Whether any MDA assistance has been availed from any source for similar activity in this financial year.

8

Amount claimed for reimbursement

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: