COMMON APPLICATION FORM is the application for all the dept

common application is the document for industries dept

1. COMMON APPLICATION FORM I
PART A
FOR ESTABLISHMENT
This format is to be filed with the Nodal Agency for the purpose of arranging site clearance, statutory approvals from
Gram Panchayat, Municipality, TC & P, Urban Development Authority, Factories, Alienation of land / Acquisition of land,
Power feasibility and Power connection from DISCOM, sanction of water supply from local bodies / Ground water for
setting up of industrial units in A.P.
(Please submit required number of copies as per check slip including one for your record)
NAME & ADDRESS OF THE PROMOTER/INDUSTRIAL UNDERTAKING IN FULL 1.1
Name of the Industrial Undertaking SUNRISE POLYMERS
Name of the Promoter/M.D./Mg. Partner with
surname first
LEELA NARAYANASETTY
S/o./D/o./W/o. DILEEP KUMAR
Age 39
Occupation BUSINESS
UID (Aadhar ID) 551144088619
ADDRESS FOR COMMUNICATION 1.2
Door No. 24
Street Name SAT NAGAR
Village/Town Thotapalem
Mandal ETCHERLA
District SRIKAKULAM
Pin Code 532005
E-mail [email protected]
Fax [phone]
Telephone (incl. STD code) 8919295583
2 Nature of Organisation : Partnership Firm
3 For Proprietary Units Only. Do you belong to : 0
Line of manufacture 4.1
S.No Item Description Annual Installed Capacity
Units Quantity
1 PRE FORM TPA 299
Application ID: CAE2502874
GOVERNMENT OF ANDHRA PRADESH
DEPARTMENT OF INDUSTRIES

2. Raw - materials used in process 4.2
S.No Name of the Raw Material Annual Installed Capacity
Units Quantity
1 VIRGIN GRANULES TPA 300
Details of Plant & Machinery (Pl. enclose list) 4.3
Brief description of manufacturing process : (Pl. enclose separate sheet) 4.4
Type and Nature of wastes and effluents their Quantities and the methods of their disposal
(Enclose Separate Sheet)
4.5
Estimated Project Cost. 5.0
Estimated Project New Unit
6.1 Land (in lakhs.) 1
6.2 Building (in lakhs .) 1
6.3 Plant and Machinery (in lakhs .) 202
6.4 Total cost of (6.1 + 6.2+6.3) (in lakhs .) 204
Probable Employment Potential :
(In No. of persons to be employed)
6.0
Male Female
Direct (On unit ¶ s payroll) 0 0
Indirect (On factory premises) 4 3
Details of existing Approvals of Factories dept Gram Panchayat / Municipality / Electricity / Water, if any 7.0
Proposed location of the factory 8.0
Proposed factory IE
Location/Name of IE/IDA/EZ/PE KUSALAPURAM
Survey No 118
Extent 720 Sq.Mts
Street Name MAIN ROAD
Village/Town KUSALAPURAM INDUSTRIAL ESTATE
Mandal Etcherla
District Srikakulam
Pin code 532410
Tele Phone No 8919295583
Nearest Tele Phone No. 8919295583
S.No Reference No Date Clearance

3. Date: 30-SEP-2025
Signature of Promoter or authorised person only in Ink
NAME (IN BLOCK LETTERS)
(DESIGNATION)
Power required for the unit 9.0
Contracted Load is 11KV or 33KV (110)
Contracted Load Maximum Demand in HP 110
Aggregate installed capacity of the transformer to be installed by
the entrepreneur in case of H.T. (H.T. means above 150 H.P.)
110
Proposed maximum working hours 24 Per day
600 Per month
Expected month and year of trial production 11 - 2025
Probable date of requirement of power supply. 15/11/2025
Total HP of the machinery proposed to be installed 110
Is Power Installation above 650V No
Hazardous Type None of the above (are Non-
Hazardous)
Water Supply and Sewer connection 10
Water Supply from Other Sources
Water requirement
i) Drinking Water 0.10 KL/Day
ii) Water for Processing (Industrial Use) 0.50 KL/Day
Size of Water Supply connection applied for 15mm(1/2 ´
Size of sewer connection applied for 15mm(1/2 ´
Area for Survey 0.07 Acres
Permission to draw water 11
Agency Ground Water
Requirement of Water Quantity 0.60KL/Day
I declare that the particulars given above are true to the best of my knowledge and belief. I shall
obey the rules and regulations in force. If any deviation is found, suitable action may be initiated.
Place :