APPENDIX - 4A

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FORMAT OF REGISTRATION-CUM-MEMBERSHIP CERTIFICATE

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Note:

Please see Paragraph 2.44 of the Policy and Paragraph 3.12.2 of this Handbook

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PART I
(To be filled in by the applicant)

1	Name and address of the applicant		:	___________________________ _________________________ __________________________
2	IEC Number		:	____________________________
3.	Address of the Head Office		:	_________________________ __________________________ ___________________________
	(i)	Registered Office	:	____________________________
	(ii)	Branch(s)	:	____________________________
	(iii)	Factory(s)	:	____________________________
4	Year of establishment		:	________________________
5.	Description of export product(s) for which registration is sought		:	_________________________
6.	Whether registration is required as merchant exporter or manufacturer exporter		:	_________________________
7.	Name of the Proprietor/ Partner(s)/ Director(s)/Karta		:	____________________________

I/We hereby declare that the above information is correct to the best of my/our knowledge and belief. I/We also undertake to abide by the conditions subject to which registration/membership is granted.

		(Signature)
	Name in Block letters	_________________________
	Designation	_________________________
	Residential Address	___________________________ ___________________________
Place: _______________ Date : _______________

PART - II
(TO BE FILLED IN BY THE REGISTERING AUTHORITY)

This is to certify that M/s_______________________(Name and address of the firm/Company) is registered with us.

Other details as per our records are as under:

(i)	Description of goods for which registered	_____________________
(ii)	Registration number	_____________________
(iii)	Registered as Manufacturer exporter or merchant exporter	______________________
(iv)	Name(s) of proprietor/partner(s)/director(s)/ Karta (s)	_____________________

This certificate is issued 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

(Expression “paragraph 2.55.2” appearing in the note to Appendix 4A corrected as “paragraph 3.12.2” vide PN. No. 12(RE-02), Dt. 2/5/2002)