APPENDIX 19B

FORMAT OF REGISTRATION-CUM-MEMBERSHIP CERTIFICATE

PART I
(To be filled in by the applicant)

1	Name of the exporter	: M/s _____________________________ _________________________________ _________________________________ _________________________________ _________________________________
2	IEC Number	: _______________________________ _________________________________ _________________________________
3.	Address of the Registered/Head Office	_______________________________ _________________________________ _________________________________
4	Date of establishment	:_______________________________ _________________________________
5.	Description of goods/ services for which registered	:_______________________________ _________________________________
6.	Registration Number	:
7.	Registered as	: a) Manufacturer exporter b) Merchant exporter c) Merchant cum manufacturer exporter ________________________
8.	Name of the Proprietor/ Partner(s)/ Director(s)/Karta	: _______________________________ _________________________________ _________________________________

This certificate is issued as per the details of our records and is subject to the conditions laid down in the relevant scheme of registration of this council.

(Signature of the competent
officer of the E.P. Council)

Name ______________________
Designation _________________
Seal _______________________

Valid/renewed upto _______________ Date of issue _________________

Space for endorsement of any amendments in this certificate

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