Application ID: (For office use)

APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTERS

EMPLOYMENT GENERATION PROGRAMME (PMEGP)
Preference for sponsoring agency of the project to Bank: (mark √ )
KVIC KVIB DIC RURAL URBAN √
TO

.
PHOTO
District Industries Center

State:
1 Name of the Applicant/Institution

7/2/1974
DD MM YYYY Age ( in Years)
2 Date of Birth: 43
2 7 1974
Male
3 Sex Male Female √ Female
4 Father's/Spouse's/Contact person Name (if Institution):
Khadi & V.I.
5 Communication Address: Khadi & V.I.
District Indu
District Indu
Taluk/Block:
District: Pin Rural
Email: Contact No: Urban
6 Address of the Proposed location of Unit: Rural Urban √
No
Yes
Taluk/Block:
District: Pin: SC
7 Name of the preferred Bank Name & Address in the Area for Project Sanction: ST
OBC
PHC
Taluk/Block: Ex- Service
District: Branch Code: Minority
Hill Boarder
8 Qualification General
Academic Technical
Under 8th Manufactur
 Whether Entrepreneur Development
9 programme (EDP at least 2 weeks) Yes No √
under gone: (mark √) Service

Period of Training ###

Certificate Issue
Name & Address of Training Institute
From To Date Under 8th
8th Pass
10th Pass
12th Pass
10 Whether the applicant belongs to (mark √) Graduate
Hill
Ex- Service
SC ST OBC PHC Minority Boarder General
man
Area Post Gradu
√ PhD
Own
Whether the project
√
Manu- Service
11 Rented
(mark √) facturing Unit Unit

12 Name of the project / business activity proposed : Leased

13 Amount of loan required (in Rs.)

Capital Expenditure Loan
Working
Building Type Workshed Machinery/ Pre
Capital /
Building Equipment/ Operative
Cash Credit Total
etc. Furniture Cost
Limit
Rented 0 0 0 0 0
Details of earlier or current Loan/Grant and subsidy availed from
14 Central/State Govt. Scheme/ or any other Similar Scheme.
Activity of the Project with Address Amount Year of Sanction

I certify that all information furnished by me is true; and that I and any of my dependent have not
borrowed any money under subsidy linked scheme from any Central / State Government or bank for
establishing any such project

Place:
Date: Signature of the Applicant

For Official Use only: (Rejected / to be placed before District Task force Committee)
Reason (if Rejected):

Place: Signature, Name & Designation of Officer

Date:
 NOTE

• Own contribution must be invested 5% for SC/ST/OBC/PHC/woman/ Ex-serviceman/ North

East Reason/Hill Boarder Area and 10% for General
• Total Project Cost should not exceed 25 lakhs for Manufacturing unit and 10 lakhs for
service unit.
• Applicant will not be entitled for additional Margin Money(Subsidy) in case of Own
Contribution over and above the prescribed limit.
• VIIIth pass for Manufacturing Unit above Rs.10 lakhs project cost and under Service Sector
above Rs.5 lakhs
• Application should be submitted complete in all respect along with attested copies of the
following documents:
1. Certificate of qualification-academic and technical (if project cost above 5 lakhs under
service industry or above 10 lakhs under Manufacturing industry)
2. Relevant Certificate for SC/ST/OBC/Minority/Ex-Servicemen/PHC
3. if Entrepreneur Development programme(EDP) training undergone (at least for two weeks)
then submit photocopy of the certificate
 DATA INPUT SHEET

Legal Status:

Land

BUILDING DETAILS
Particulars Area Rate/Sq.ft Amount in Rs.
0.00
0.00
0.00 ###
0.00
0.00
0.00
0.00
0.00

MACHINERY DETAILS
Particulars Qty. Rate Amount in Rs.
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Total 0.00

d. Preliminary & Pre-operative Cost :

e. Furniture & Fixtures :

f. Contingency/Others/Miscellaneous 0.00

Working Capital : 0.00

 Means of Financing

Own Contribution : 5%
Bank Finance : 95%
Margin Money (Govt. Subsidy) 25%

DETAILS OF SALES
Rate/ Qantity Amount in Rs.
Particulars of Products
Unit
Stone carving products 0.00
Stone Artware & Decorative Prod. 0.00
0.00
0.00
0.00
0.00
0.00
Total 0.00

RAW MATERIALS
Particulars Unit Rate/Unit Reqd. Unit Amount In Rs.
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 0.00

WAGES
No. of Wages Per Month Amount in Rs.
Particulars
Worker Total Month 12
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 0 0.00
 SALARY DETAILS
No. of Wages Per Month Amount in Rs.
Particulars
Staff Total Month 12
0.00
0.00
0.00
0.00
0.00
Total 0 0.00

WORKING CAPITAL ESTIMATE

Element of Working Capital No. of Days
Raw materials

Stock in process

Finished goods

Receivable by

POWER ESTIMATE
Power Requirement

Repair and Maintanance Rs. 0.00

Power and Fuel Rs. 0.00

Other Overhead Expenses Rs. 0.00

Telephone Expenses Rs. 0.00

Stationery & Postage Rs. 0.00

Advertisement & Publicity Rs. 0.00

Building Rent Rs. 1000.00

Other Miscelleneous Expenditure Rs. 0.00

Rate of Interest

Depreciation
On Building 5.00%
On Machinery 10.00%

Pay back period 5

Project Implementation Period 2 12

INTRODUCTION

ABOUT THE PROMOTER

Office Address:
.
District Industries Center
0
0
0 State: 0

Name & Signature Incharge

with round seal
 DISTRICT INDUSTRIES CENTER
PROJECT AT A GLANCE - TOP SHEET
1 Name of the Entreprenuer 0

2 Constitution (legal Status) Individual

3 Father's/Spouce's Name 0

4 Unit Address : 0
0
Taluk/Block: 0
District : 0
Pin: 0 State: 0
Phone 0
E-Mail 0

5 Product and By Product

6 Cost of Project : Rs. 0

7 Means of Finance
Term Loan Rs. 0.0
KVIC Margin Money Rs. 0.00
Own Capital Rs. 0.00

8 Debt Service : #DIV/0!

Coverage Ratio

9 Pay Back Period : 5 Years

10 Project : 12 Months
Implementation
Period

11 Break Even Point : #DIV/0!

12 Employment : 0

13 Power Requirement : 0

14 Major Raw materials : ,,

15 Estimated Annual : Rs. 0.00

Sales Turnover

PMEGP Project Report Page 8

 DETAILED PROJECT REPORT
1 INTRODUCTION :

2 ABOUT THE PROMOTER :

3 COST OF PROJECT
A. Fixed Capital Investment
a. Land : 0 Own

b. Workshed Area Sq.ft Rate in Rs. Amt. In Rs.

0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0.00
0
C. Machinery Qty. Rate Amount in Rs.
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0.00

PMEGP Project Report Page 9

 d. Preliminary & Pre-operative Cost : Rs. 0.00

e. Furniture & Fixtures : Rs. 0.00

f. Contingency/Others/Miscellaneous Rs. 0.00

Total Capital Expenditure : Rs. 0.00

Working Capital : Rs. 0.00

Total Cost Project : Rs. 0.00

3.1 Means of Financing :

Own Contribution 5% Rs. 0.00

Bank Finance : 95%

Term Loan Rs. 0.00
Working Capital Rs. 0.00

Total Rs. 0.00

Margin Money (Govt. Subsidy) From KVIC 25% Rs. 0.00

Margin Money Subsidy received From KVIC will be kept in term deposit as per norms of
PMEGP in the name of Beneficiary for three years in the financing branch.

3.2 STATEMENT SHOWING THE REPAYMENT OF TERM LOAN & WORKING CAPITAL :
TERM LOAN

Interest @
Year Opening Balance Installment Closing Balance
0.00%
1st 0 0 0 0
2nd 0 0 0 0
3rd 0 0 0 0
4th 0 0 0 0
5th 0 0 0 0
6th 0 0 0 0
7th 0 0 0 0
8th 0 0 0 0

WORKING CAPITAL

Interest @
Year Opening Balance Installment Closing Balance
0.00%
1st 0 0 0 0
2nd 0 0 0 0
3rd 0 0 0 0
4th 0 0 0 0
5th 0 0 0 0
6th 0 0 0 0
7th 0 0 0 0
8th 0 0 0 0

PMEGP Project Report Page 10

 3.3 STATEMENT SHOWING THE DEPRECIATION ON FIXED ASSETS:
WORKSHED @ 5.00%
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Opening Balance 0 0 0 0 0
Depreciation 0 0 0 0 0
Closing Balance 0 0 0 0 0
MACHINERY @ 10.00%
Opening Balance 0 0 0 0 0
Depreciation 0 0 0 0 0
Closing Balance 0 0 0 0 0
TOTAL DEPRECIATION
Workshed 0 0 0 0 0
Machinery 0 0 0 0 0
Total 0 0 0 0 0

4 Schedule of Sales Realization :

4.1 Details of Sales
Rate/ No. of Amount in Rs.
Particulars of Product Pair/Unit Pair/Unit
0
Stone carving products 0.00 0 0.00
Stone Artware & Decorative Prod. 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
Total 0.00

4.2 Capacity Utilization of Sales

Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year

Capacity Utilization 70% 80% 90% 90% 90%

Sales / Receipts 0 0 0 0 0

5 Rawmaterials :
Particulars Unit Rate/unit Reqd.Unit Amount in Rs.
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
Total 0.00
5.1 Wages :
No. of Wages Amount in Rs.
Particulars Worker Per Month (Per Annum)
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0 0.00

PMEGP Project Report Page 11

 5.2 Repairs and Maintenance : Rs. 0.00

PMEGP Project Report Page 12

 5.3 Power and Fuel : Rs. 0.00

5.4 Other Overhead Expenses : Rs. 0.00

6 Administrative Expenses :
6.1 Salary
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0.00 0.00
0 0.00 0.00
Total 0 0.00

6.2 Telephone Expenses 0.00

6.4 Stationery & Postage 0.00

6.5 Advertisement & Publicity 0.00

6.6 Workshed Rent 12000.00

6.7 Other Miscellaneous Expenses 0.00

Total 12000.00
7 Capacity Utilization of Manufacturing & Administrative Expenses :
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Capacity Utilization 70% 80% 90% 90% 90%
Manufacturing Expenses
Rawmaterials 0 0 0 0 0
Wages 0 0 0 0 0
Repairs & Maintenance 0 0 0 0 0
Power & Fuel 0 0 0 0 0
Other Overhead Expenses 0 0 0 0 0
Administrative Expenses
Salary 0 0 0 0 0
Postage Telephone Expenses 0 0 0 0 0
Stationery & Postage 0 0 0 0 0
Advertisement & Publicity 0 0 0 0 0
Workshed Rent 12000 12000 12000 12000 12000
Other Miscellaneous Expenses 0 0 0 0 0
Total: 12000 12000 12000 12000 12000
8 Assessment of Working Capital :
Particulars Amount in Rs.
Sale 0.00

Manufacturing Expenses
Raw Material 0.00
Wages 0.00
Repair & Maintenance 0.00
Power & Fuel 0.00
Other Overhead Expenses 0.00

Production Cost 0.00

Administrative Cost 12000.00
Manufacturing Cost 12000.00

PMEGP Project Report Page 13

 Working Capital Estimate :
Element of Working Capital No of Day Basis Amount in Rs.
Raw materials 0 Material Cost 0.00

Stock in process 0 Production Cost 0.00

Finished goods 0 Manufacturing Cost 0.00

Receivable by 0 Manufacturing Cost 0.00

Total Working Capital Requirement Per Cycle 0.00

9 Financial Analysis
9.1 Projected Profit & Loss Account :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Sales / Receipts 0 0 0 0
0 0 0 0
Manufacturing Expenses
Rawmaterials 0 0 0 0
Wages 0 0 0 0
Repairs & Maintenance 0 0 0 0
Power & Fuel 0 0 0 0
Other Overhead Expenses 0 0 0 0
Depreciation 0 0 0 0
Production Cost 0 0 0 0
Administrative Expenses
Salary 0 0 0 0
Postage Telephone Expenses 0 0 0 0
Stationery & Postage 0 0 0 0
Advertisement & Publicity 0 0 0 0
Workshed Rent 12000 12000 12000 12000
Other Miscellaneous Expenses 0 0 0 0
Administrative Cost 12000 12000 12000 12000
Interest on Bank credit @ 0%
Term Loan 0 0 0 0
Working Capital Loan 0 0 0 0
Cost of Sale 12000 12000 12000 12000
Net Profit Before Tax -12000 -12000 -12000 -12000
Less Tax 0.00 0.00 0.00 0.00
Net Profit -12000 -12000 -12000 -12000

9.2 CALCULATION OF DEBT SERVICE CREDIT RATIO (D.S.C.R) :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit -12000 -12000 -12000 -12000
Add :
Depreciation 0 0 0 0
TOTAL - A -12000 -12000 -12000 -12000
Payments :
On Term Loan :
Interest 0 0 0 0
Installment 0 0 0 0
On Working Capital
Interest 0 0 0 0
TOTAL - B 0 0 0 0
D.S.C.R = A/B
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
Average D.S.C.R

PMEGP Project Report Page 14

 9.3 PROJECTED BALANCE SHEET :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
LIABILITIES :
Promoters Capital 0 0 0 0
Profit -12000 -12000 -12000 -12000
Term Loan 0 0 0 0
Working Capital Loan 0 0 0 0
Current Liabilities 0 0 0 0
Sundry Creditors 0 0 0 0
-12000 -12000 -12000 -12000
ASSETS :
Gross Fixed Assets : 0 0 0 0
Less : Depreciation 0 0 0 0
Net Fixed Assets 0 0 0 0
Preliminary & Pre-Op. Expenses 0 0 0 0
Current Assets 0 0 0 0
Cash in Bank/Hand -12000 -12000 -12000 -12000
Total -12000 -12000 -12000 -12000

9.4 CASH FLOW STATEMENT :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit -12000 -12000 -12000 -12000
Add : Depreciation 0 0 0 0
Term Loan 0 0 0 0
Working Capital Loan 0 0 0 0
Promoters Capital 0 0 0 0
Total -12000 -12000 -12000 -12000

Total Fixed Capital Invested 0

Repayment of Term Loan 0 0 0 0

Repayment of WC Loan 0 0 0 0
Current Assets 0 0 0 0
Total 0 0 0 0

Opening Balance 0 -12000 -24000 -36000

Surplus -12000 -12000 -12000 -12000
Closing Balance -12000 -24000 -36000 -48000

9.5 BREAK EVEN POINT AND RATIO ANALYSIS :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Fixed Cost 12000 12000 12000 12000
Variable Cost 0 0 0 0
Total Cost 12000 12000 12000 12000

Sales 0 0 0 0

Contribution (Sales-VC) 0 0 0 0

B.E.P in % #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Break Even Sales in Rs. #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Break Even Units #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Current Ratio #DIV/0! #DIV/0! #DIV/0! #DIV/0!

PMEGP Project Report Page 15

 Net Profit Ratio #DIV/0! #DIV/0! #DIV/0! #DIV/0!

PMEGP Project Report Page 16

 This Project Report has been prepared based on the data furnished by the entrepreneur whose
details are given in the application.
Place : 0
Date: 30-Dec-99
Prepared by :
.
District Industries Center
0
0
0 State 0 Full Name :
e-Mail: 0
Ph. No.: 0 Signature of the Beneficiary
Fax: 0

Name & Signature Office Incharge

with round seal

PMEGP Project Report Page 17

 PROJECT REPORT FOR

Affix latest
attested
Photograph

1 Name of the Entreprenuer 0

1
2 Constitution (legal Status) Individual

3 Father's/Spouce's Name 0

5 Unit Address : 0
0
Taluk/Block: 0
District : 0
Pin: 0 State: 0
Phone 0
E-Mail 0

6 Background of the Proprietor/Partners/Directors : Furnished detailed information in the DPR

7 Name of Business House/Group if any :

8 Details Other Companies/Units in the group :

Other Companies / Units in the Group (Rs. in Lakhs)
Name & Address Business Equity Reserves Loans Turnover *P.B.T **P.A.T
of Company / Unit

* Profit Before Tax ** Profit After Tax

`

8.1 How the activity was financed so far : ( To be filled up in case of existining unit Only )
*Source of Funds Security Rate of Repayment per Present O/s Amount of Default
Interest Month ( Rs. in '000 ) (if any)

8.2 If the Unit is an ancillary one, undertaking to

which it is catering and its address :
8.3 Employment : Present Proposed
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
Total 0

9 Project Details for Proposed New Unit : Copy of detailed project report is enclosed.
a Expansion / Mordenisation :

b Setting up of New unit :

c Activity for proposed new unit :

d Product / Item proposed to undertake :

9.1 Capacity (Furnish the details of Installed capacity & production : (No. in Units/ Qty. in Kg./Volume in liter per annum)
Capacity is arrived at on the basis of Days working on shift basis
Product & Present Installed Maximum Prod. Proposed Installed Maximum Prod.
By-product if any Capacity Achieved Capacity of 1st Year envisaged
70.00% 0

9.3 State the manufacturing process in brief :

9.4 Has the proposed process ever been tried in the
country or newly adopted? :

9.5 Technical Arrangements :

9.6 Describe arrangement for Key Official

for managing the proposed unit :
Technical Manpower

Administrative Manpower

Accounting personnel

9.7 Particulars of Land Existing Proposed

Location of the Land :
Area of Land
Status of the Land
Nature of Land
Availability of Water :

9.8 Particulars of Building Existing Proposed

(Enclose the plan & Estimation for the proposed Building) Area Value in Rs. Status Area Value Status
Factory Building :

Ancillary Building

Storage

Total 0.00 0.00

9.9 Plant and Machinery Existing (Value in Rs.) Proposed (Value in Rs.)
Indigenous 0.00

Imported

(Enclose the plan layout of the existing plant and machinery )

9.10 Rawmaterials / Components
Req. of Raw material/Components/Chemicals Qty. in Nos./Kgs./Ton Rate/Nos./Kgs/Tons Value in Rs.

Total 0.00

9.11 Utilities (Furnish details on requirement, availability, adequacy, qualitative aspects etc..)
Particulars of Utilities Contracted Load Connected Load Further requirement
in HP/KW/W in HP/KW/W in HP/KW/W
Power

Water

Fuel

Others (Specify)
9.12 Environment Aspect of the Project :

9.13 Requirement of Manpower for the Project :

Particulars of Manpower Total Requirement Salary/Wages per month Cost per Annum
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0 0.00

9.14 Schedule of Implementation : BAR CHART

Activities Date of Commencement Expected Date of Completion
a. Acquisition of Land
b. Development of Land
c. Civil Works for Factory / Building
Machinery / Foundation etc..
d. Plant & Machinery
Imported
Indigenous
e. Arrangement for power
f. Arrangement for water
g. Errection of equipment
h. Commissioning
I. Procurement of Raw materials/Chemicals
j. Trail Runs
k. Commercial Production
10 Cost of Project :
(Rs. in '000)
Sr.No. Particulars Already Incurred To be Incurred Total Cost
A Land including Development 0.00 0.00

B Building & Other Civil Works 0.00 0.00

C Plant and Machinery

1. Indigenous 0.00 0.00
2. Imported 0.00

D Furniture & Fixture 0.00 0.00

E Testing equipment 0.00

F Miscellaneous Fixed Assets 0.00

G Errection & Installation Charges 0.00

H Contingency 0.00 0.00

I Preliminary & Pre-Op. Cost 0.00 0.00

J Provision for
1. Buildings 0.00
2. Plant & Machinery 0.00
3. Other Fixed Assets 0.00

K Working Capital for one 0.00 0.00

Operating Cycle

L Total 0.00 0.00 0.00

 11 Means of Financing :
(Rs. in '000)
Sr.No. Particulars Amount already Amount Proposed Total
Raised to be Raised
A Equity / Promoters Contribution 0.00 0.00

B Reserves 0.00

C Term Loans 0.00 0.00

D Unsecured Loans and Deposits 0.00

(Indicate sources, roi, repayment etc)

E Deferred Payment 0.00

Arrangements including Suppliers credit

F Subsidy
Central Government 0.00 0.00
State Government 0.00

G Seed Capital 0.00

H Internal Cash Accruals 0.00

I Other Sources (Specify) 0.00

J Total 0.00 0.00 0.00

11.1 In case internal accruals are taken as

source of finance explain the basis of
estimation of internal accruals :

11.2 Indicate source from which expenditure

already incurred has been financed :

11.3 % of Promoters contribution of the :

total cost of project
 12 Marketing & Selling Arrangements of the Product :

13 Projected Profitability : Projected Profitability Statement given in the

Detailed Project Report.

14 Projected Cash flow Statement : Projected Cash flow Statement given in the
Detailed Project Report.

% of Cash Sales in Total Sales :

Period in which payment is received Days

in respect of Credit Sales

Average Credit Available on Purchase : Days

15 Working Capital Required for the : Rs. 0.00

anticipated turnover

16 Repayment Programme : Detailed Repayment programme for Term loan and

Working capital loan have been given in the DPR.

17 Details of Securities to be Offered :

17.1 Primary ( Furnish details for term loan and : :

working capital loan separately )
17.2 Collateral, if any (Details) :

17.3 Details of Guarantor(s) :

1. Name
2. Residential Address :

3. Occupation :
4. Details of movable & immovable
properties owned by him /her/other
family members

5 Details of any other similar guarantees:

if any, given to other institutions

18 Government Consents :
(Give deatails of various licenses / consents required to be obtained from various authorities for the proposed project)

19 DECLARATION

I / We hereby declare that the information given herein before and the statements and other
papers enclosed are, to the best of our knowledge and belief, true and correct in all particulars

Date : 0 Signature of the Borrower

Place : 0 Name & Designation (In case of Regd. Inst.)
 Project Report on

Prepared By:
.
District Industries Center
0
0
0 State: 0
e-Mail:
Ph. No.: Fax: