System Botanical Manufacturers

1. Name of Manufacturer (Firm)* (Complete name as mentioned in document establishing the entity))

2. Address of Manufacturing Premises (Complete Factory Address with City, Pin Code & State/U.T., Country) Address *

3. Address of Regd. Office/Office (if different from 2 above) (Complete address with City, Pin Code & State/U.T., Country) Address*

4. Other location(s) of the firm where also manufacturing activities are carried out * (Separate applications need to be submitted for each such location for recognition)

5. Contact Details of the Firm (Give Telephone No., Mobile Nos., Email Id)

6. Type of Firm & Legal Identity (Proprietorship, Partnership, Ltd. Pvt. Ltd., LLP, Govt., PSU etc.)*

7. Scale of Firm a) Large Scale/MSME * Select Large Scale MSME b) In case of MSME, mention Udhyam/ other relevant Registration Nos. & Date

* 8. Licence to manufacture Botanicals/Herbal Products (Mention name of the authority and Licence No. & Date)

9. Management of Firm* (Name & Designation of Top Management & Key Functionaries)

10. Whether firm has in-house laboratory for testing and assuring quality (Yes/No) * Select Yes No

11. Quality Control Personnel (Mention Names & Designations of Head of QA/ QC)

12. Botanicals/Herbal Products manufactured * (Give complete list with Name, Types/variety, as applicable)

13. Botanicals/Herbal Products for which recognition is sought (Give complete list with Category, Product Name, Types/variety, as applicable)

14. Credentials in support of seeking recognition for products at 13. above

15. Adverse reporting/action by the regulatory/certifying body, if any (Give details, if any action imposed)

16. Name and Address of Consultancy Firm/Consultant engaged (If any for any botanical manufacturing related activities)

17. Payment of Application Fees (Mode of Payment, Txn Id, Payment Date, Cheque No & Bank etc.)

18. Any other Information (Give additional information, if any, which the applicant may like to submit in support of and relevant to the application)

19. Declaration –

It is hereby declared that the information, as provided above are true and the documents attached in support of the application pertain to us and are authentic. I undertake to inform AYUSHEXCIL, in case there is change in status in respect of any information or the attached document (s).

* Application to be signed by Proprietor, Partner, Managing Director, Director, CEO etc. or in his absence, by his authorized representative.