FORM-V

 

CLAIM FORM FOR PUBLICITY ABROAD FOR FINANCIAL ASSISTANCE

 

1Name of the SSI unit with full address and e-mail ID (if any)
2In principal approval letter number and date
3Details of the event where publicity material was released, along with dates (Actual copy of publicity material to be enclosed)
4No. of copies of publicity material prepared
5Total expenditure incurred (Attach copy of payment voucher/receipt)
6Total amount claimed
7Whether the SSI unit has been charged/ prosecuted/debarred/blacklisted/under investigation under Exim Policy or
any other law relating to export import business
8Whether 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:

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