ANF 4J

For Advance Authorisation / Advance Release Order (ARO) / Invalidation letter for Pharmaceutical Product, manufactured through Non-Infringing (NI) process

[Please see paragraph 4.7A of HBP. v1 and the guidelines (given at the end of this ANF) before filling the application].

1. IEC Number

2. Applicant Details

i. Name

ii. Address

3. RCMC Details

i. RCMC Number

ii. Date of Issue

iii. Issuing Authority

iv. valid upto

v. Products for which registered

4. Industrial Registration Details

i. SSI / IEM / LOI or IL Registration Number

ii. Date of Issue

iii. Issuing Authority

iv. Products for which registered

5. Excise Details (For those registered with Central Excise Authority)

i. Excise Registration Number

ii. Issuing Authority

6. Status House Details:

i. EH / SEH / TH / STH / PTH

ii. Certificate Number

iii. Date of Issue

iv. Issuing Authority

v. Valid Upto

7. Application Fee Details

i Amount (Rs)

ii Demand Draft / Bank Receipt / Electronic Fund Transfer No

Iii Date of Issue

iv Name of the Bank on which drawn

v Bank Branch on which drawn

8. Total CIF value of Imports applied for

i. In Rupees

ii. In currency of imports

iii. In US $

9. Total FOB / FOR value of Exports to be made, excluding commission

i. In Rupees

ii. In currency of exports

iii. In US $

10. Value Addition (in %):

11. Port of Registration as per paragraph 4.19 of HBP v1 (for the purpose of imports):________.

12. Country of Import (Destination Country):

13. Whether approval of the Food & Drug Administration / Concerned regulatory authority of the country of import received for the product: Yes / No.

14. Details of items to be exported / supplied under the Authorisation:

S No	Item Description	Item Technical Characteristics / Quality etc.	ITC (HS) Code	Quantity	Unit of Measurement	FOB / FOR Value (in Rs)	FOB / FOR value (in freely convertible currency)

15. SION or Adhoc Norms for the export product:

i. Whether SION fixed for the product: Yes / No

If yes, then state SION Sl. No.: _________.

ii. Whether Adhoc Norms fixed: Yes / No.

If yes, then state:

NC meeting No.: ____;

NC meeting date: _________;

Case No.: ____.

16. Details of items sought to be imported duty free under the Authorisation

S. No	Item Description	Item Technical Characteristics / Quality etc.	ITC (HS) Code	Quantity in metric units	CIF Value (in Rs)	CIF value (in freely convertible currency)	Total exemption from Customs duty

17. Details of other materials to be used in the export product and sought to be imported / procured from sources other than the Authorisation on which drawback benefits is to be availed (not to be filled if Drawback benefits are not being claimed):

Sl. No		Imported Item		Indigenously Procured Item
Name, Technical Characteristics / Quality etc	Quantity in metric units	CIF Value	Name, Technical Characteristics / Quality etc	Quantity in metric units	Value

18. Details of Outstanding Export Obligation against Advance Authorisation(s) issued already:

S No	Authorisation No	Authorisation Date	CIF Value (Rs)	FOB Value (Rs)	%age of EO fulfilled		Expiry Date of EO period
					Qty wise	Value wise

19. Details of exports / deemed exports (including Intermediate supplies) made in the preceding 3 licensing years:

Licensing Year	FOB Value of exports (in Rs Crore)	FOR Value of deemed supplies (in Rs Crore)	Total Export Performance (in Rs Crore)

20. In case of request for issuance of ARO / Invalidation letter, please furnish:

i. Advance Authorisation No.:
ii. Date of Issue of Advance Authorisation:
iii. Name (s) of the Indigenous producer from where items are to be procured:
iv. Address (s) of the Indigenous producer from where items are to be procured:
v. Regional Authority of the Indigenous producer:
vi. Items to be supplied by the Indigenous producer:
a. Description of individual items:
b. Quantity of individual items to be procured:
c. Value of individual items to be procured:

21. Address of the factory / premises where the items to be imported are proposed to be used:

22. Address of the jurisdictional Central Excise Authority under whose jurisdiction the factory / premises falls:

DECLARATION / UNDERTAKING

1. I / We hereby declare that the particulars and the statements made in this application are true and correct to the best of my / our knowledge and belief and nothing has been concealed or held there from. If found incorrect or false, it will render me / us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.

2. I / We undertake to abide by the provisions of FT(D&R) Act, the Rules and Orders framed there under, the FTP, HBP v1, HBP v2 and the ITC(HS) Classification of Export & Import Items.

3. I / We hereby certify that none of the Proprietor/ Partner(s) / Director(s) / Karta / Trustee of the firm / company, as the case may be, is / are a Proprietor / Partner(s) / Director(s) / Karta / Trustee in any other firm / Company which has come to the adverse notice of DGFT.

4. I / We hereby certify that the Proprietor / Partner(s)/Director(s) / Karta / Trustee, as the case may be, of the firm / company is/are not associated as Proprietor/Partner(s)/Director(s) / Karta / Trustee in any other firm / company which is in the caution list of RBI.

5. I / We hereby declare that I/we have perused the list of SCOMET items as contained in the Appendix 3 to the Schedule 2 of the ITC (HS) Classifications of Export-Import Items, 2004-09 and that the item(s) exported / proposed to be exported does not fall within this list and that I/ We agree to abide by the provisions of the Policy for export of SCOMET items contained in the Foreign Trade Policy, Schedule 2 of ITC (HS) and the HBP v1, irrespective of the scheme under which the item is exported / proposed to be exported (the underlined portion will be deleted in case an application for export license for SCOMET item is being filed).

6. I / We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which RBI permission has been obtained.

7. I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 9.9 of the FTP.

Place Date

Signature of the Applicant Name Designation Official Address Residential Address Email: Telephone No.(O):

GUIDELINES FOR APPLICANTS

(Please see paragraph 4.7 A of HBP v1)

A. For Advance Authorisation:

1. Two copies of the application must be submitted unless otherwise mentioned.

2. Each individual page of the application has to be signed by the applicant.

3. RCMC details need not be given if the same have already been updated in the IEC.

4. Bank Receipt (in duplicate) / Demand Draft / EFT details evidencing payment of application fee in terms of Appendix 21B.

5. In case of supplies to another advance Authorisation holder, original invalidation letter(s) shall be submitted. However, in case of switch over from physical exports / deemed exports to intermediate supplies, such invalidation letters can also be furnished at the time of redemption of advance authorisation.

6. Chartered Engineer (Chemical) certificate certifying the input requirements of raw materials in the format given in Appendix 32C.

7. A self certified copy of the approval letter for the product, from the Food & Drug Administration / Concerned regulatory authority of the country of import (Destination country).

8. In cases where import of fuel has been sought for under Advance Authorisation:

a. Self certified copy of the permission issued to the manufacturer exporter by the competent authority (concerned State Electricity Board or Power Corporation or Regulatory Commission of the State) under Section 44 of the Electricity (Supply) Act, 1948 for the installation of captive power plant based on the specified fuel unless the permission is specifically waived by the State Electricity Board; and

b. Self certified copy of the letter intimating the date of commissioning of the captive power plant from the concerned authority which issued the permission letter is to be submitted.

Note: Import of only such fuel(s) shall be allowed which have / has been specified in the said permission.

B. For ARO / Invalidation letter:

Applicant may furnish information in respect of Sl. No. 1, 2 & 20 of the application only.

C. Please state ‘Not Applicable’ wherever the information / data is not applicable to you.

(Above ANF 4J has been appended vide PN. NO. 29/2010, DT. 14/02/2011)