MSME Submission Form

MSME Basic Information

Name of the MSME

Please enter the name of your MSME

UDYAM Registration Number

Please enter your UDYAM registration number

MSME Category

Micro Enterprise

Small Enterprise

Medium Enterprise

Other

Please select your MSME category

Contact Information (Preferably MD and CEO)

Name

Please enter the contact name

Designation

Please enter the designation

Mobile

+91

Please enter a valid 10-digit mobile number

Email Address

Please enter a valid email address

Financial Performance & Borrowing Details

Financial Performance (Rs. in Lakhs)

Particulars	As on March 31, 2024	As on March 31, 2025
Total Revenue	₹	₹
Out of above Export Revenue	₹	₹
Total Net Worth	₹	₹
Net Profit	₹	₹

Details of Borrowing (Rs. in Lakhs)

Name of the Bank

Type of Credit Facility

Amount

₹

Business Information

Business Details

Briefly explain the Business of the company

Please provide a brief explanation of your business

Total Number of Employees on the payroll

Please enter the total number of employees

Total Number of Women Employees

Please enter the number of women employees

Do you have ZED Certification?

Yes

No

Please select an option

Did you avail any Government Schemes / Subsidy available for MSMEs?

Yes

No

Please select an option

Awards & Recognition

Details of the Awards conferred on you in recognition of your extraordinary performance under MSME sector

Additional Details

Additional Contributions & Innovations

Highlight any other notable achievements, innovations, or unique contributions that the MSME has made to its industry or community (Max. 300 words)

0 words

Stock Information (If Applicable)

Name of the Stock Exchange

Current Stock Price

₹

External Credit Rating & Additional Information

External Credit Rating, if applicable

Any other information you would like to furnish

Processing Fee Details

Details of processing fees paid, as per concept note

Please provide details of processing fees paid

Declaration

Declaration and Undertaking

I hereby declare that:

All the information provided in this application form is true and correct to the best of my knowledge.
I understand that providing false information may result in rejection of the application and/or disqualification.
I authorize the relevant authorities to verify the information provided herein.
I confirm that I have read and understood all the terms and conditions related to this application.
I undertake to inform the concerned authorities of any changes in the information provided.

I confirm that the information provided is accurate and I agree to the declaration above.

You must agree to the declaration to proceed

Name of the Authorized Signatory

Please enter the name of the authorized signatory

Designation

Please enter the designation

Date

Please select a date

Place

Please enter the place