APPENDIX 39

APPLICATION FOR FREE SALE & COMMERCE CERTIFICATE

1.	Name of the firm / Company	:
2.	Address of Registered Office	:
	(i) Tel No	:
	(ii) Fax No	:
	(iii) e.mail ID
3.	Importer Exporter Code No (i) Code No. (ii) Name & Address of issuing authority	:
4.	Registration –cum-Membership Certificate ( RCMC ) details (i) Name of the Council (ii) Registration No and date (iii) Validity
5.	Brief Description of exports (i) Details of foreign buyer with complete address, e.mail ID etc. [Deleted- (ii) Export Order No. & Date ] (iii) Brief description of items to be exported under the certificate	:
6.	Whether the items of export fall under the Drugs & Cosmetics Act. 1940 . If so, indicate the same.	:
7.	Details of items for which Free Sale & Commerce Certificate is sought to be obtained (Annexure A to be attached duly self-certified)
(Above 5 (ii) has been deleted vide PN.No. 92/2005, DT. 09/03/2006)

(Signature)
Name & Designation of the Authorised Signatory
Seal of the Company

Note :

1. This form with Annexure ‘A’ may be submitted without other parts of the Aayat Niryat Form.

[Deleted-
2. Self Certified Copy of export order to be attached with the application.]

(Above Note 2 has been deleted vide PN.No. 92/2005, DT. 09/03/2006)

3. For items falling under the Drug & Cosmetics Act,1940, application for issue of Free Sale & Commerce Certificate may be made to the Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi-110011.

ANNEXURE A

Sl No.	Name of the equipment / item

(Above Appendix 39 has been vide PN NO. 61/2005, DT. 13/10/2005)

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