Name of the Proposer

Factory Address

Factory Contact Number

Factory Fax Number

Office Address

Office Contact Number

Office Fax Number

Constitution ConstitutionSole ProprietorshipPartnershipLimited Liability PartnershipPrivate Limited CompaniesPublic Limited CompaniesOne-Person CompaniesSection 8 CompanyJoint-Venture CompanyNon-Government Organization (NGO)

Whether registered as Whether registered asSSIMedium ScaleLarge Scale

Representatives

Type of Activity Type of ActivityPlastic ProcessorDealing in Plastic Raw materials/Machines & Accessories/ Additives & ChemicalsMachinery ManufacturerConsultantInstitutionAssociation

Products Manufactured /Services provided (write all)

Processing Machines Installed - Primary Processing (Tick All Applicable) Processing Machines Installed - Primary Processing (Tick All Applicable) Extrusion Blow Molding Injection Molding Thermoforming Any other

Processing Machines Installed - Converting Equipment (Tick All Applicable) Processing Machines Installed - Converting Equipment (Tick All Applicable) Rotogravure Printing Flexo Printing Screen Printing Lamination Slitting / Rewinding Coating Bags & Pouch Making Stitching & Sacks Making Any other

Any other (Specify)

Raw Materials Consumed (Polymers) Raw Materials Consumed (Polymers) LDPE LLDPE HDPE PP PVC PS Masterbatch Engineering Polymers Any other

Whether: Whether: VIRGIN REPROCESSED

Raw Materials Consumed (Film and Foil Stock) Raw Materials Consumed (Film and Foil Stock) BOPP Film Polyester Film Hot Stamping Foil Lamination Film Polycoated Al Foil Polycoated Paper Any other

Whether: Whether: VIRGIN REPROCESSED

Any other (Specify)

Total Investment in Fixed Assets Rs.

Annual Consumption

No. of workers employed (Skilled)

No. of workers employed (Semiskilled)

No. of workers employed (Unskilled)

Special Achievements/Products Developed

Any other information

Declaration Declaration I/we undertake to abide by the Rules & Regulations and Bye laws of The Vidarbha Plastic Industries Association. I/We am/are enclosing herewith

Cash/Cheque/DD No.

Amount in Rupees

Name

Name of Proposer (VPIA Member)

Date

Place