Annexure-II
“INDIA HANDLOOM” BRAND
APPLICATION FORM
1. DETAILS OF THE APPLICANT
1.1) Name of the Applicant :
1.2) Category of the Applicant:
(Registered Cooperative society/Companies /Partnership Firm/other institutions/individuals
producing handloom fabrics/hand-block printer/garment manufacturer)
1.3) Registration no. and Date of Registration :
( in case of society, corporation, company and other institutions )
or
Weaver Identity Card No/Aadhar Card No/Ration Card No. :
( in case of individuals)
(Please enclose a self certified photocopy of Registration certificate/Identity
card)
1.4) Address
(i) Location :
(ii) Post office :
(iii) District :
(iv) State :
(v) Pin code :
(vi) Telephone :
(vii) Fax :
(viii) Email :
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2. PRODUCTION PROFILE
SL No. PRODUCT DESCRIPTION/ QUANTITY/VOLUME (LAST FINANCIAL YEAR)
PRODUCT Total Cotton Cotton Silk Wool Silk Wool Others
SPECIFICATION (all Silk blend
fibres) blend
1 2 3 4 5 6 7 8 9 10
2 SARI
3 DHOTI
4 DRESS
MATERIAL
5 SCARF/
STOLE/
SHAWL
6 BED SHEET/
BED COVER
7 HOME
FURNISHING
8 GARMENTS
9 MADE-UPS
9 OTHERS
3. Production center:
3.1) Location:
3.2) Facilities available:
3.2.1) Weaving/ Designing:
3.2.2) Dyeing:
3.2.3) Facility for treatment of effluent:
3.2.4) Stitching/garmenting:
3.2.5) Testing facility:
4. TURNOVER ( Rupees in Lakhs) for the last 3 years
Sl.No. Mode 2015-16 2016-17 2017-18
1 Direct sale in counter
2 Export
3 Sale to Apex
Society/Corporation
4 Bulk sale to trader
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5 Sale in Exhibitions
6 Others
7 Total
5. Name of the product for which application is being made
Sl. category of Sub-category (Name count count ends picks length width
No the of the item) of of per per
product warp weft inch inch
(Please enclose photographs of the products)
6. Undertaking :-
(i) I Shri/Smt_________________________________ hereby undertake that the
products carrying India Handloom brand shall confirm to specifications including
maintenance of quality provided in the “India Handloom” Brand initiative.
(ii) It is stated that I have engaged no child labour and also stated that the
products are environment compliant, as the dyes, which releases the banned
amines, are not used in the production process.
(iii) I do hereby undertake that I shall abide by the guidelines of “India
Handloom” brand scheme in letter and spirit.
(iv) I further undertake that all the information given above is true to the best of
my knowledge and belief. In case of any violation of the terms and conditions, my
registration will be withdrawn as per rule.
Date
Place SIGNATURE
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