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