Owner Details 1. Owner Type PROPRIETOR 2.Name of proprietor SOVAN SOURAV RATH 3. Relation FATHER 3(A). Relation's Name DHRUBA KISHORE RATH 4. Gender MALE 5. Date of Birth 12-May-1983 6. Permanent Address 6(A). State ODISHA 6(B). House No,Street/Lane, Village , AT-GURUJANGULI P.O.-CHAINPAL 6(C). Pin Code 759104 Post Office, etc. COLONY VIA-TALCHER DIST.-ANGUL 7. Correspondence Address 7(A). State ODISHA 7(B). House No,Street/Lane, Village , AT-GURUJANGULI P.O.-CHAINPAL 7(C). Pin Code 759104 Post Office, etc. COLONY VIA-TALCHER DIST.-ANGUL 8. PAN Card number1 PALRPR9866M 9. Telephone No.(Land Line) 6760249139 10. Mobile 9439898434 11. E-mail sovonrath@gmail.com 12. Sales Tax No./ TIN No 2174350139 13. Mill Operated By SELF 13. Lessee Details 13(A). Name of Lessee 13(B). Relation 13(C). Relation's Name 13(D). Gender 13(E). Date of Birth 13(F). Permanent Address State House No,Street/Lane, Village , Post Pin Code Office, etc. 13(G). Correspondence Address State House No,Street/Lane, Village , Post Pin Code Office, etc. 13(H). PAN Card Number 13(I). Telephone No.(Land Line) 13(J). Mobile 13(K). E-mail 13(L). Sales Tax No./ TIN No Mill Details 14. Mill Name NITYAN RICE MILL 15. Year of Establishment 2010 16(A). Raw Rice Output per 8Hour 16. Mill Type PARABOILED 0 shift(In MT) 16(B). Parboiled Rice Output per 8Hour 17(A). Storage Capacity of Rice ( in 16 500 shift(In MT) MT) 17(B). Storage Capacity of Paddy(in 1000 18. Source of Electricity ELECTRICITY UTILITY MT) 19. Consumer number Allotted by 0 20. Power Rating of Mill in KVA 57 Electricity Utility 20(A). Electricity Consumed During 20(B). Electricity Consumed During KMS(2017-2018) KMS(2018-2019) 20(C). Electricity Consumed During 21. Mill PAN Card No ALRPR9866M KMS(2019-2020) 22. State Pollution Control Board SPC394AGL 22(A). SPCB licence Valid Upto 15-Jul-2012 licence No to be obtened(NEWLY 23. RMC Licence No. 23(A). RMC licence Valid Upto 01-Jan-1900 ESTABLISHED) 24. Registration No. from Inspector of 24(A). Registration No. from Inspector OR/601 18-May-2012 Factories and Boilers of Factories and Boilers Valid Upto 25. IS Cross Dist NO 25(A). Is Active YES Mill Location 26(A). District ANGUL 26(B). Block/ULB. TALCHER 26(C). Tahasil TALCHER 26(D). Police Station TALCHER 26(E). Mauza GHANTPADA 26(F). Khata No 379 17&18 TALCHER INDUSTRIAL 26(G). Plot No ESTATE Declaration : I hereby declare that all the particulars furnished in this application are correct to the best of my knowledge. I shall be held responsible for any incorrect information.
Signature of Mill Proprietor : _____________________________ Date :____________________
Checked & verfied with field information at the site of miller registration and (found to be correct)/(necessary modification has been done to place correct facts) Signature Of Verifying Officer : ___________________________ Name (In Capital Letters) : _______________________________