ANF 5A

APPLICATION FORM FOR EPCG AUTHORISATION ISSUE

{Please see guidelines (given at the end) before filing the application}

I. IEC Number

2. Applicant Details

i. Name

ii. Address

3. RCMC Details

i. RCMC Number

ii. Date of Issue and valid upto

iii. Issuing Authority

iv. Products for which registered

4. Type of Exporter (please tick)

i. Merchant Exporter

ii. Manufacturer Exporter

iii. Merchant cum Manufacturer - Exporter

iv. Service Provider - Exporter

v. Others( please specify)

5. Industrial Registration Details

i. SSI / IEM/LOI or IL Registration Number

ii. Date of Issue

iii. Issuing Authority

iv. Products for which registered

[ DELETED- 6. Drug Manufacturing license Details

i. Drug Manufacturing License Number

ii. Date of Issue

iii. Issuing Authority

iv. Products for which registered ]

(Above no. 6 has been deleted vide PN. No. 109/2008, DT. 17/11/2008)

7. Service Tax Registration Details ( In case of Service providers registered with Service Tax authorities)

i. Service Tax Registration Number

ii. Issuing Authority

iii. Services for which registered

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

i. Excise Registration Nimber

ii. Date of Issue / Issuing Authority

9. Status House Details

i. EH / SEH /TH / STH / PTH

ii. Certificate Number

iii. Date of Issue and valid Upto

iv. Issuing Authority

10. Application Fee Details

Amount (Rs)

Demand Draft/Bank Receipt/Electronic Fund Transfer No

Date of Issue

Name of the Bank and branch on which drawn

11. Sector Classification of Capital Goods sought to be imported under the Scheme (Please tick)

i. Industrial sector

ii. Agricultural sector

iii. Port sector

iv. Service sector

v. Retail sector

vi. Others

11A. whether imports made are also Project Imports as per Para 5.1B of Policy                     Yes / No

11B. whether imports made are under Technological Upgradation Scheme                     Yes / No If yes, give following details:

Sr No	FOB Authorisation No	FOB Authorisation Date	FOB Value / duty saved	FOB fixed in freely convertible currency	%age of FOB fulfilled	Expiry date of FOB period
1	2	3	4	5	6	7

11C. Details of Freely Importable Capital Goods applied for import
S No	Description of the items of import	ITC(HS) Code	Nature of Capital Goods sought to be imported +	Primary Use of Capital Goods sought to be imported ++
1	2	3	4	5

Technical Specifications/ Model No. etc	Quantity	CIF Value
6	7	8

11D. Details of Restricted Capital Goods applied for import
S No	Description of the items of import	ITC(HS) Code	Nature of Capital Goods sought to be imported +	Primary Use of Capital Goods sought to be imported ++
1	2	3	4	5

Technical Specifications/ Model No. etc	Quantity	CIF Value
6	7	8

11E. Total CIF value of CG to be imported:

+ - whether Capital Goods / Spares / Tools /Jigs / Fixtures / Dies / Moulds /spare Refractories / Catalyst.

++ - whether used for Pre Production activity/ Production activity/ Post Production activity/ For rendering Services

(From amongst col.11Cand 11D above please fill up whichever is applicable. In case applicant desires to import both restricted and freely importable capital goods appropriate information should be given in both the cols.)

11F. In case the CG proposed to be imported is under restricted category following information with regard to the sponsoring authority may be furnished ( To be furnished wherever applicable)
Ministry / Department recommending the case
Recommendation letter no. and date
11G (a). Port of Registration for purpose of imports
11G (b). Address of the Factory/Premises
11G (c). Supporting manufacturer details In case the proposed CG sought to be imported are to be used by supporting manufacture, please furnish i. Name of Supporting Manufacturer: ii. Address of supporting manufacturer iii. SSI / LOI / IL Regn. No. & Date of Supporting Manufacturer iv. Product endorsed on SSI/IL/IEM: (of Supporting Manufacturer) v. Excise Reg. No. and issuing authority (if applicable) (of supporting manufacturer)

12. Details of Duty Saved

Total effective Customs duty on items to be imported/deemed to be imported (in %) +++	Duty to be levied under the Scheme(in %)	Duty Saved (in %)	CIF Value of imports/deemed imports (in Rs)	Duty saved(in Rs)
1	2	3 = 1 - 2	4	5

Note:

i. +++ in case of indigenous sourcing of CG , duty saved is to be calculated on notional custom duty saved on FOR Value of CG as per para 5.7A of FTP

ii. In case of EPCG Authorization for projects as per para 5.1B of Policy, the basic customs duty would be 7.5%. wherever CVD is paid in cash and not subsequently cenveted, CVD would not be taken for computation of net duty saved.

13. Whether any export obligation has been imposed in the Letter of Intent/Industrial Licence/Foreign Collaboration approval                         Yes/No

I .If yes, please furnish details thereof including FOB fulfilled, if any

ii. In case of Service Provider, please furnish

a. Serial No of Appendix 36 under which classified

b. Whether registered with Service tax authorities                     Yes / No

14. Products to be exported/Services to be rendered

15A. Details of exports made in preceding 4 licensing years same and similar products (including exports against all pending EPCG Authorisations)
Sl.No.	Financial Year	Amount of Export of same product / services	Export Amount for similar product / services	Export Amount for alternate / other product / services	Total
1	2	3	4	5	6 =3+4+5
1.
2.
3.
4.
Total
15B. Export Channel Details
Sl.No.	Financial Year	Direct Exports By applicant firm itself	Through Third party Exports	Through Group company	Total
1	2	3	4	5	6 = 3+4+5
1.
2.
3.
4.
Total (1+2+3+4)
15C. Details of Group Company Exports
1. Group company Name
2. Date of Incorporation
Sl.No.	Financial Year	Product Particulars	Direct Exports Value	Value of Group Company Exports through third party	Total
1	2	3	4	5	6 = 4+5
1.
2.
3.
4.
Total

16. EPCG Authorisations already obtained till date.
S.No	EPCG Authorisation No and Date	Products to be exported/services to be rendered	RA which issued Authorisation	CIF Value / Duty saved (Rs)	Expiry Date of E.O. Period	Redemption Date / Remarks
1	2	3	4	5	6	7
(i)	Redeemed cases during the last 4 years (year-wise)
	Total:
(ii)	Not redeemed cases
	Total:

16 (Contd.)
Sl. No.	EPCG Authorization Details & Date	Average EO (over complete EOP)		Specific EO on CIF / Duty Saving (over complete EOP)		Total EO
		Fixed	Fulfilled	Fixed	Fulfilled	Fixed	Fulfilled
1	2 (as in 16)	8	9	10	11	12 = 8+10	13 = 9+11
(i)	Redeemed EPCG Authorization
	Total (i)
(ii)	Non-Redeemed EPCG Authorization
	Total (ii)
	Grand Total (i + ii)

17A. Details of Export Obligation (Average and Specific):
Average Export Obligation to be imposed (Rs) (as shown in sr.no.15(A) [Total of Col (3+4) of row (2+3+4)/3]		Total duty saved (Rs.) as per column no.5 at sr.no.12.	Specific Export Obligation to be imposed (as a multiple of duty saved)		Total Export Obligation imposed
(Rs.)	(USD)		(Rs.)	(USD)	Rs.	USD
1	2	3	4	5	6	7

17B. Export obligation Period: (8 year/ 12 years) :

Note: For Premier Trading Houses, exercising option of average over 5 years, all the above details must be given for 2 more years.

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 and if found incorrect or false 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 the Foreign Trade (Development and Regulation) Act, 1992, the Rules and Orders framed there under, the Foreign Trade Policy, the Handbook of Procedures 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 neither the Registered Office/Head Office of the firm/company nor any of its Branch Office(s) / Unit(s) / Division(s) has been declared a defaulter and has otherwise been made ineligible for undertaking import / export under any of the provisions of the Policy.

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 Handbook of Procedures (Vol.1), irrespective of the scheme under which the item is exported / proposed to be exported.

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

7. I / We hereby declare that the capital goods/spares sought for import in the application are actually required for use at pre production/production/post production stages for the export product(s) or for rendering services for fulfilment of export obligation.

8. I / We hereby declare that in respect of goods for which nexus is not established at a later date, I / We shall pay to the Government Customs duty saved together with 15% interest on such imported goods which are found having no relation with product exported or service rendered.

9. I / We hereby declare that in case of import of refurbished/reconditioned spares, the refurbished/reconditioned spares have a residual life which is not less than 80% of the life of the original spares.

10. I / We hereby declare that I / We do not come under the purview of Service Tax and therefore are not registered with the Service Tax Cell of the jurisdictional Central Excise Authorities. (in case of Service Providers who are not covered under service tax)

11. I / We hereby declare that I/We shall not exceed the SSI investment limit in plant and machinery after making imports under the EPCG Authorisation. (applicable in cases of imports made by SSI sector)

12. I / We hereby declare that the import of capital goods shall be used for building and operating shopping malls/super markets having a minimum covered area of 1000 sq meters. (Applicable in case of imports made by Retail sector).

13. I / We hereby declare that I/We have not made imports under the Technological Upgradation Scheme previously before any Licensing authority and the present imports of Capital Goods to be made under this Scheme (for which this application is made) are more than 10% of the my/our present investment in the plant and machinery. (applicable in case of imports under EPCG Technological Upgradation Scheme)

13(a). I/We undertake to submit a self certified copy of ‘Drug Manufacturing Licence’ in case of export of Pharmaceutical Product(s) within a period of three years from the date of issue of EPCG Authorization failing which the Bank Guarantee /Legal Undertaking executed/furnished at the time of clearance of Capital Goods with Customs authorities/Regional Authorities of DGFT, as the case may be, is liable to be forfeited/invoked and I/We would be liable to pay Customs Duty saved amount together with applicable interest thereon from the date of first import till the date of final payment.

(Above Sl. No. 13(a) has been added vide PN. No. 109/2008, DT. 17/11/2008)

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

(Note: Strike out the clause which is not applicable.)

Signature of the Applicant Name Designation Official Address Telephone Residential Address Email Address

Place Date

GUIDELINES FOR APPLICANTS

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. In case CG sought to be imported is under restricted category, a copy of this application shall be sent to EFC at DGFT HQRS also. (In such cases no separate application fee shall be required to be submitted while sending the copy of the application to Hqrs. EFC). Upon clearance by EFC, EPCG authorisation shall be issued by RA and will bear an endorsement that EFC has approved issue of EPCG Authorisation for restricted CG.

4. Application must be accompanied by documents as per details given below:

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

(2) Self certified copy of IEM/SSI registration number in case of products and a self-certified copy of Service Tax Registration in case of Service Providers.

(In case of Service Providers, who are not registered with Service Tax Authorities and a declaration in this regard has been submitted as a part of the application (Declaration No.10), Service Tax Registration is not required to be submitted. In such cases, RCMC from EPC concerned will suffice).

(Above Sl. No. 4(2) has been amended vide PN. No. 109/2008, DT. 17/11/2008)

[OLD-

(2) Self certified copy of Drug Manufacturing License in case of export of Pharmaceutical product or self certified copy of IEM/SSI Registration Number in case of other products or a self certified copy of Service Tax Registration in case of Service Providers.

. (In case of Service Providers, who are not registered with Service Tax authorities and a declaration in this regard has been submitted as a part of the application (declaration no.10) , service tax registration is not required to be submitted. In such cases RCMC from EPC concerned will suffice). ]

(3) Certificate from a Chartered Engineer in the format given in Appendix 32A certifying:

a. the end use/nexus of machinery sought for import under EPCG Scheme in the pre production/production/post production activity of the exported goods/services (explaining the end use of machinery in detail); and/or

b. the essentiality of spare parts sought for import and its required quantity for existing machinery manufacturing the goods to be exported/ machinery sought for import; and/or

c. complete usage of equipments/goods sought for import under the EPCG Scheme for supply of service to overseas customers/ service consumers of any other country in India to earn free foreign exchange/supply of service in India relating to export paid in free foreign exchange.

(4) Statement of exports made/services rendered by the applicant firm during the preceding three licensing years duly certified by a Chartered Accountant / Cost and Works Accountant in the format given in Appendix 26 as applicable.

a. In case of import of spares for existing plant and machinery, a list of plant/machinery imported and already installed in the factory/premises of the applicant firm/supporting manufacturer for which the spares are required, duly certified by a Chartered Engineer or jurisdictional Central Excise authority

b. In case of EPCG applications made by EOU/SEZ units, a self certified copy of the `No Objection Certificate’ from the Development Commissioner concerned showing the details of the capital goods imported/indigenously procured by the applicant firm, its value at the time of import/sourcing and the depreciated value for the purpose of assessment of duty under the Scheme is to be submitted.

(5) Copy of previous EPCG Authorisation (in case application is made under EPCG Technological Upgradation Scheme).

(6) In case of import of restricted capital goods under ITC(HS) a self certified copy of the recommendation letter by the Sponsoring authority.( To be enclosed in case the same has already been obtained)

5. For example, if the application is in Financial Year 2008-09, then details may be given for 2004-05 and onwards.

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