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SELF CERTIFICATION
FOR CONTINUATION OF OPERATION DURING COVID-19 LOCKDOWN PERIOD
Name of the Company
Address of the Plant
District
--District--
BAGALKOT
BELAGAVI
BELLARY
BENGALURU RURAL
BENGALURU URBAN
BIDAR
CHAMARAJANAGAR
CHIKKABALLAPUR
CHIKKAMAGALUR
CHITRADURGA
DAKSHINA KANNADA
DAVANAGERE
DHARWAD
GADAG
HASSAN
HAVERI
KALABURGI
KODAGU
KOLAR
KOPPAL
MANDYA
MYSORE
RAICHUR
RAMANAGAR
SHIVAMOGGA
TUMAKURU
UDUPI
UTTARA KANNADA
VIJAYAPURA
YADAGIRI
Taluk
--Taluk--
Industry located in
--Area--
Name of the Industrial Area/Industrial Estate
--Ward--
Industry Category
--SELECT INDUSTRY STATUS--
MICRO
SMALL
MEDIUM
LARGE
Is your unit Export Oriented Unit
Yes
No
Name of the Proprietor / Partner/ Director
Mobile Phone No. of Proprietor / Partner/ Director
Enter Mobile OTP
Email Id
GST NUmber
Activity Category
--Select--
Industrial Activity
IT/BT
Total No. of employees working
Agree with Terms & Conditions of Annexure 2