*
Indicates mandatory
:
1.
Owner Type
*
Proprietor
PartnerShip
Company
:
2.
Name of Proprietor
*
:
2.
Name of Managing Director
*
:
3.
Relation
*
--Select--
Father
Husband
:
3. (a).
Relation's Name
*
:
4
Gender
*
Male
Female
:
5
Date of Birth
*
:
5 (a).
Aadhaar Card No of Proprietor
*
:
5 (a).
Aadhaar Card No of Managing Director
*
:
5 (b).
Registered Partnership Deed in case of partnership firm
*
6.Permanent Address
:
6.A
State
*
Odisha
:
6.B.
Pin Code
*
:
6.C.
House No,Street/Lane, Village , Post Office, etc.
*
Correspondence Address
Tick if Permanent and Correspondence Address is same
7. Correspondence Address
:
7.A
State
*
Odisha
:
7.B.
Pin Code
*
:
7.C.
House No,Street/Lane, Village , Post Office, etc.
*
:
8.
PAN Card Number
*
:
9.
Telephone no. (Land Line)
*
:
10
Mobile
*
:
11
E-mail
*
:
12
GST No
*
:
12.A
GST Certificate
*
:
13
Mill Operated By
*
SELF
LESSEE
Lessee Details
13.A.
Name of Lessee
*
13.B.
Relation
*
-Select--
Father
Husband
13.C.
Relation's Name
*
13.D.
Gender
Male
Female
13.E.
DOB
*
13.F.
Permanent Address
*
State
select
odisha
others
Pin Code
*
House No,Street/Lane, Village , Post Office, etc.
*
13.G.
Correspondence Address
*
Tick if Permanent and Correspondence Address is same
State
select
Odisha
Others
Pin Code
*
House No,Street/Lane, Village , Post Office, etc.
*
13.H.
PAN Card Number
*
13.I.
Telephone No.
(Land Line)
*
13.J.
Mobile
*
13.K.
E-mail
*
13.L.
GST No
*
13.M
GST Certificate
*
13.N
Land Lease deed
Mill Details
:
14.
Mill Name
*
:
15.
Year of Establishment
*
--Select Year-->
:
16.
Mill Type
*
Select
Hybrid
:
17.
Raw Rice Output per 8Hour shift (In MT)
*
:
18.
Parboiled Rice Output per 8Hour shift (In MT)
*
:
19.A.
Storage Capacity of Rice (in MT)
*
:
19.B.
Storage Capacity of Paddy(in MT)
*
:
19.C.
Source of Electricity
*
--Select--
OWN CPP
Electricity Utility
BOTH
:
19.D.
Source of Electricity Provider
*
--select--
TPCODL
TPNODL
TPSODL
TPWODL
:
19.E.
Consumer Number Allotted by Electricity Utility
*
:
19.F.
Power Rating of Mill in KW
*
:
19.G.
Electricity Consumed During KMS(
)
*
:
19.H.
Electricity Consumed During KMS (
)
*
:
19.I.
Electricity Consumed During KMS (
)
*
:
19.J
Mill PAN Card No
*
:
19.K
State Pollution Control Board licence No
*
:
19.L
SPCB licence Valid Upto
*
:
19.M
SPCB Certificate
*
:
19.N
Meter Type
*
Select
SMART METER
:
19.O
Meter No
*
:
19.P
Copy of last month Electricity Bill of the mill along with receipts
*
:
20.
RMC Licence no.
*
:
20.A.
RMC licence Valid Upto
*
:
20.B.
RMC Certificate
*
:
21.
Registration No. from Inspector of Factories and Boilers
*
:
21.A.
Registration No. from Inspector of Factories and Boilers Valid Upto
*
:
21.B.
Registration No. from Inspector of Factories and Boilers Certificate
*
:
21.C
Factory Certificate No.
*
:
21.D.
Factory Certifcate Document
*
:
22.
EIN (Employer Identification Number)
*
:
22.A
Udyam Registration Certificate No.
:
22.B
Udyam Registration Certificate
:
22.C
Registrar of Firms Certificate No.
:
22.D
Registrar of Firms Certificate
:
23
Blending Machine Installation
*
Yes
No
:
24
Panchayat NOC No.
*
:
24.A.
Panchayat NOC Certificate
*
:
25
NOC for Ground Water Abstraction No.
*
:
25.A.
NOC for Ground Water Abstraction Certificate
*
:
26
Food License(FSSAI) Certificate No.
*
:
26.A.
Food License(FSSAI) Valid upto
*
:
26.B.
Food License(FSSAI) Certificate
*
:
27
Weight Bridge Installed?
*
Yes
No
:
27.A.
Weight Bridge Capacity
*
Mill Location
:
1.
District Name
*
--Select--
ANGUL
BALASORE
BARGARH
BHADRAK
BOLANGIR
BOUDH
CUTTACK
DEOGARH
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHPUR
JAJPUR
JHARSUGUDA
KALAHANDI
KANDHAMAL
KENDRAPARA
KEONJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NAWARANGPUR
NAYAGARH
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SUBARNAPUR
SUNDERGARH
:
2.
Block / ULB Name
*
--Select--
:
3.
Tahasil
*
--Select--
:
4.
Police Station
*
--Select--
:
5.
Mauza
*
:
6.
Khata no.
*
:
7.
Plot no.
*
