APPENDIX 22A

BANK CERTIFICATE OF EXPORT AND REALISATION

FORM NO. 1
To ______________________________________( Name and address of Regional Authority ) We _____________________________________ (Name and address of the Exporter ) hereby declare that we have forwarded a documentary export Bill to _____________________________ ( Name and address of the Bank i.e., Branch and City) for collection / negotiation / purchase as per particulars given hereunder.

Invoice		Export promotion copy of Shipping Bill duly authenticated by the Customs		Description of goods as given in the Customs Authenticated Shipping Bill and the Commercial Invoice/Packing List [OLD- Description of goods as given in the customs authenticated Shipping Bill ]	Bill of Lading / PP Receipt / Airways Bill		Destination of goodsCountry name	Bill amount CIF / C&F / FOB(In foreign exchange
No.	Date	No.	Date		No.	Date
[1]	[2]	[3]	[4]	[5]	[6]	[7]	[8]	[9]

(In above table heading of column no. 5 has been replaced vide PN. No. 21/2007, DT. 17/07/2007)

Freight amount as per Bill of lading/Freight memo	Insurance amount as per insurance Company"s bill/ Receipt	Commission / Discount paid/payable	Whether the export is in freely convertible currency or in Indian Rupees	FOB value/FOB value actually realised in free Foreign Exchange / Rupees	Date of realisation of export proceeds	GRI/PP/SDF form No.	No. date & category of applicable authorisation
[10]	[11]	[12]	[13]	[14]	[15]	[16]	[17]

We further declare that the aforesaid particulars are correct. (Copies of invoices relevant to these exports and Customs attested EP, Copy of relevant Shipping Bill is attached for verification by the bank).

	Signature of the exporter	: ...........................................
	Name in block letters	: ...........................................
Place:		: ...........................................
Date:	Designation	: ...........................................
	Full official address	: ...........................................
Official Seal/stamp	Full Residential address	: ...........................................

BANK"s CERTIFICATE
Authorised Foreign Exchange Dealer
Code No. allotted to the Bank by RBI ______________________________
Ref.No. ___________________________
Date _____________________________
Place ____________________________

1. This is to certify that we have verified the relevant Export Invoices, Customs attested E.P. Copy of the Shipping Bill and other relevant documents of M/s.___________________________. We further certify that the particulars given in Co.1 to 17 have been verified and found to be correct. We have also verified the F.O.B. value mentioned in Col.14 above with reference to following documents:-

(i) Bill of Lading / PP receipt / Airways Bill
(ii) Insurance policy / Cover / Insurance Receipt.

2. FOB actually realized and date of realization of export proceeds are to be given in all cases except where consignment has been sent against confirmed irrevocable letter of credit or exports made against the Government of India/EXIM Bank Line of Credit or exports made under Deferred Payment/Suppliers Line of Credit Contract backed by ECGC Cover. An endorsement to that effect needs to be endorsed in BRC.

3. We have also verified that the date of Export is _________. ( Applicable only in respect of Exports by air.)

4. This is to certify that we have certified the amount of the Commission paid/payable, as declared above, by the exporter i.e. ____________________________________________(in figures and words) with G.R. Forms and found to be correct.

(Signature of the Bankers)

Full address of the Bankers
Branch and City
Official Stamp

Note: 1. Bank can issue a consolidated certificate (consignment-wise) for more than one consignment.

2. FOB actually realised and date of realisation of export proceeds are to be given in all cases except where consignment has been sent against confirmed irrevocable letter of credit. However for status holders, irrevocable letter of credit would suffice.

3. This shall be required wherever specifically prescribed in the Policy / procedure.

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