Entrepreneur Registration Form

Fields marked with *(asterisk) are mandatory.
Entrepreneur Information
Name of Applicant/Firm/Company/Enterprise:*
Office Address:*
Pincode:*
E-mail Id:*
Website Address (if any):
Enterprise Nature of Activity:*
Name of Product/Service:* (e.g. Cement Industry)
Enterprise Category:*
Type of Organisation:*

Project Site Address:
District:*
Tehsil:
Village/Town:
Select Industrial Area:

Contact Information
Authorised Contact Person:*
Designation of Contact Person:*
PAN No./ Voter ID No./ Passport No.
of authorised person of the enterprise:*
Telephone No:
Mobile :
Fax:
E-mail Id:*
Total Project Cost:*
(in Lakhs)  
Website Information Manager - Shri Sanjeev Saxena (Jt. Dir.)    Phone:  0141-2227727     Email: sanjeev.saxena@mail.com
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