FORM 5

[See Clause 9(A)(ii)]

Provisional Entitlement Certificate

(For 50% exemption of Stamp Duty and/or Conversion Charges)

(Under Rajasthan Investment Promotion Scheme, 2003)

Book No. Date :

S.No.

It is certified that M/s _________________________________________, whose application for the project ____________________________________ at _________________________________ (address), has been registered at No. __________ dated ___________, and based on his declaration, he is entitled to avail following exemptions under Notifications No. _______________ & ___________ Dated ______________.

1. 50% of the Stamp Duty* and / or

2. 50% of the Government portion of Conversion Charges*

(Signature with Seal)

Member Secretary

(Prescribed Authority under the RIPS, 2003)

State Level Screening Committee /

District Level Screening Committee

* The relevant authority of Government of Rajasthan responsible for administering these duties and / or levies, suo moto or on being informed otherwise, shall recover the amount so exempted along with interest @ 18* p.a., in case of any violation of the provisions contained in the Rajasthan Investment Promotion Scheme 2003, by the bearer of this Certificate.

C.C. :

1. M/s _________________

2. Concerned Department.

MEMBER SECRETARY