Annexure ‘VI’

Annexure 'VI' - ISO-9000 Form


Name of the Industry: ____________________________

Address: ____________________________ ____________________________


Phone Number: ____________________________

(in Triplicate)
Received a sum of Rs.__________________(Rupees ____________ ________________________________________) from the Development Commissioner (Small Scale Industries) towards the reimbursement of expenses incurred for obtaining International Quality Certification ISO – 9001 / ISO – 14001.

Rubber Stamp of the Unit

*Signature of the Authorized Person (on Revenue Stamp)



Passed for the payment for Rs.__________________(Rupees_________________ _____________________________________) Vide sanction No._____________ ______________dated_________________

Asstt. Director

Office of the Development Commissioner (SSI)

Nirman Bhavan, New Delhi – 110 011.

Note : Please read the instructions on pre-page carefully before filling this Annexure VI i.e. Pre-Receipt.


Note : Please follow the following instructions while Preparing this Annexure VI given in next page.

  • Please ensure you prepare the Annexure VI in A-4 size paper only.

  • Please ensure you give Annexure VI in triplicate.

  • Please type the name of your industry, full address and telephone numbers as indicated in the sample format, in the portion marked A.

  • Please do not fill in the amount in the pre-receipt. Leave the portion blank. The office of DC (SSI) will fill it up after calculating the amount due to you.

  • Please ensure the authorized person of your unit signs at the places indicated for signatures of the authorized person on revenue stamp.

  • Please type portion ‘B’ yourself in the A-4 size paper as indicated in the format.

  • Office of the DC (SSI) will fill up the amount and the sanction no. in the spaces provided for the same.

  • The Assistant Director concerned will sign at the place earmarked for his signature.