Application Form for Seeking Equity Grant by FPC

Name of the FPC :	*
State :	*
District :	*
Correspondence Address :	*
Contact No. :
Mobile No. :	*
Email ID :	*
Registration No. :	*
Registration Date/ Incorporation of FPC(dd/mm/yyyy) :
Business of FPC :	*
No. of Shareholder Members :	*
No. of Small,Marginal and Landless Shareholder Members :	*
Authorised Capital (in INR) :	*
Paid Up Capital (in INR) :	*
Amount. of Equity Grant Sought (in INR) :	*
Maximum Shareholding of an Individual Shareholder Member: Only decimal values are allowed!	*
Maximum Shareholding of an Institutional Member : Only decimal values are allowed!	*

Bank Name in which account is maintained :	*
Branch Name :	*
Branch Address :	*
Bank Email ID :
IFSC Code :	*
Account No. :	*
No. of Directors :	*
No. of Women Directors :	*
Dates of Board Meetings held in the last year(dd/mm/yyyy) :	*
No. of Functional Committees of the FPC : (Mention the major activities of each committee)	*
Roles & Responsibilities of Board of Directors :	*

Details of Board of Directors:

#	Name of BoD Members	Designation/Role in FPC	DIN No.	Qualification	Tenure(in Yrs.)	Contact No./Address	Land Holding (in Acres)
1
2
3
4
5
6
7

Details of RI/Consultant:

Name	Contact No	Address	Email ID

Checklist

S.No	Checklist*	Note: 1)All checklist file must be in pdf/image/zip file. 2)Each file size must be less than 2 MB
1	Application on prescribed form duly signed by two Board Members/Authorised Representative of FPC on each page.
2	Category wise allotment pattern of shares of FPC and proposed computation of allotment of shares out of Equity Grant may be submitted on the lines of Annexure-I.
3	Resolution of the FPC Board/Governing Council to seek Equity Grant, issue of shares to the shareholders against Equity Grant and transfer of shares (issued against Equity Grant) in case of exit of any shareholder from FPC may be submitted on the lines of Annexure -II.
4	The Resolution will be ratified in the next AGM of the FPC may be submitted on the lines of Annexure -III.
5	Resolution for appointment of Chief Executive officer of Company.
6	Audited Financial Statements for last financial year.
7	Photocopy of Bank Account Statement for last six months duly authenticated by the Branch Manager of the Bank.
8	KYC documents of only those Representatives/Directors authorised by the Board of FPC for executing and signing documents with SFAC.
9	Certificate of incorporation/commencement of business, Memorandum of Association/Articles of Association.
10	Business plan for 18 months.

Note: Hard copies along with enclosure to be submitted separately to SFAC registered office NCUI Auditorium Building, 5th Floor, 3, Siri Institutional Area, August Kranti Marg, Hauz Khas, New Delhi - 110016. (T) +91-11- 26966017, 26966037, 26862365 (F) +91-11- 26862367
Checklist