Annexure ‘V’
 

Annexure 'V' - ISO-9000 Form

 

To be submitted by the Applicant on a Non-judicial Stamp paper of Rs. 50/-(Min) in Delhi /amount as applicable in the respective State duly sworn before a Notary Public (duly affixed with Notarial Stamp; and with Notary Seal & Notary Registration number) or First Class Magistrate

UNDERTAKING/ DECLARATION

  • I————————-s/o———————Managing Director/Director/Proprietor/Partner, M/s.——————————with Regd. office at————————— & factory located at————————————————-and with E.M. No.———dt.————— do hereby solemnly affirm and declare as under:
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  • (i) That the aforesaid Company/Firm/Establishment(s) have not availed reimbursement/subsidy/grant/incentive for acquiring, ISO 9000/ISO-14001 Certification under any Scheme operated by Central Govt. (including o/o DCSSI, M/o SSI)./ State Govt./ Financial Institution etc.
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    OR
     

  • (ii) That the aforesaid Company/Firm/Establishment(s) have claimed & received reimbursement/subsidy/ grant/incentive for acquiring ISO 9000/ISO-14001 Certification amounting to Rs__________ (Rupees __________ from _____________(Name of the Central Govt/State Govt Deptt./Financial Institution vide draft/cheque No———–dt———- of————(Name of Bank)
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  • (i) That the aforesaid Company/Firm/Establishment(s) have already applied to——–Name of the Central Govt (other than O/o DCSSI)/ State Govt/ Financial Institution ) vide application dated——–for reimbursement/ subsidy/ grant/incentive for acquiring ISO- 9000/ISO-14001 Certification .
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    OR
     

  • (ii) That the aforesaid Company/Firm/Establishment(s) have not applied to any Central Govt./State Govt./Financial Institution (except o/o DC(SSI), Ministry of SSI), for reimbursement/subsidy/grant/incentive, for acquiring ISO-9000/ISO-14000 Certification.
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  • That after availing reimbursement for ISO-9000/14001/HACCP Certification from Office of DC(SSI), Ministry of SSI, in respect of the said Company/Firm/Establishment(s), I shall disclose this fact on behalf of the said Company/Firm/Establishment(s) at the time of claiming/ receiving reimbursement subsidy/grant/incentive, if any, under any other similar scheme run by Central Govt./State Govt. Financial Institutions etc.
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  • I hereby solemnly affirm that the information given above is correct. In case above declaration is found wrong or incorrect or misleading, I do hereby bind myself & my unit and undertake to pay to the Government on demand the full amount received as reimbursement in respect of above mentioned activity, within seven days of the demand being made to me in writing.
  • Partner/Proprietor/ Managing Director/ Director

    In the presence of:

  • (Full Name and addresses of the two witnesses also to be indicated along with signatures)
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    Note: The factual status as on date under the respective paras at (a); (b) & (c) above must be clearly indicated