TIDEL PARK COIMBATORE LTD. Regd. Office: No.4, Rajiv Gandhi Salai Taramani, Chennai – 600 113 Site: ELCOSEZ, Aerodrome Post Coimbatore – 641 014 Contact Ph: 0422-2513604 Fax: 0422-2513609 Web: www.tidelcbe.com Mail: [email protected] APPLICATION FORM (For Leasing of IT / ITES Space) IT Park Location: ELCOT-SEZ IT/ITES Villankurichi, Aerodrome Post Coimbatore – 641 014 1.0 PARTICULARS OF APPLICANT Name of Applicant Name of the Authorised person Designation Address of Company / Firm Telephone Number Mobile Fax Email Website URL PAN No. GST & TIN No. Relevant Information, Local contact address and telephone number may be given in the case of a foreign firm or a company. 2. SPACE REQUIREMENTS ( sq. ft) : ______________ Sq.ft. (Super built-up area) 3. Module Preference : ______________ 4. Please specify the proposed usage / activities: Approved Upgrade of software Computer-related Technical Service Centre services CAD/CAM/CAE IT Product Data processing Support Demonstration E-Commerce IT Training Data Warehousing Computer Systems Computer System Communication Design Integration Equipment Design Office Automation Back office for R & D Laboratory (IT and Equipment banks/financial institutes related) Design E-Mail/Internet/Intranet/Extranet SPECIFIC APPROVAL System Customizing Publishing (with Communication Service Centre printing) Prototype Making Project Planning & Management Audio / Video product Design Engineering Design & Equipment & component Applications Engineering Development Centre Merchatronics Components Design & Development Electronic Workshop-Repair System Integration of Data Comn. Equipment- Consultancy Services 6. Lease Period (Please indicate) : 7. Token Advance amount payable : Rs. _______________ along with application form (10 months rent) 8. UTILITIES SERVICE REQUIREMENTS (i) Electricity (estimated) a. Average Daily energy Consumption (kWh) b. Electrical Load Required (Connected) (KVA) (ii) Communication (required) Telephone lines Nos. ISD Lines Nos. Leased Lines kbps 9. EMPLOYMENT (expected) No. of employees to be housed Nos Projected man power to be required for operations at optimum level. 10. OTHER RELEVANT INFORMATION (a) Two copies of the Certificates of incorporation (Companies Act) and the Memorandum & Articles of Association of the company are to be attached (for Private Limited Company) (b) Two copies of the Certificate of Registration (Business Registration Act / Indian Partnership Act) and Registration Form showing the particulars of the sole proprietorship / partnership (c) Necessary supporting documents in case of IT professionals / individuals. (d) Brochures of Company, Products and Services, Nature of business (e) Latest Company's Annual Report or Audited Accounts. (f) Company's brief and the business plan for the next five years (g) All shareholders / Partners and their respective shareholdings are to be clearly indicated. (h) Copies of Company PAN and GST (i) If a foreign company, the relevant documents for carrying out business in India may be provided. (j) Any other information relevant to support the application 11. Payment Details a) Module No. b) Area (super built-up) c) Advance Payment Rs. d) RTGS / NEFT details Place : Signature : Date : Name : Designation : Company Seal : .