APPENDIX- 17-A
APPLICATION FOR GRANT OF EXPORT HOUSE/ TRADING HOUSE/ STAR TRADING HOUSE /SUPER STAR TRADING HOUSE FOR SERVICE PROVIDERS

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Note:

1. Please see Note-1 of paragraph 3.7.2 of the Policy and paragraph 3.2 of this Handbook.

2. Please read the general instruction given at Appendix 1 before filling this application.

3. Please submit 2 copies of this application form.

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FOR OFFICIAL USE

File No.:-------------------------------- Date:-------------------------------

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1.	Name and address	:	..................................... ..................................... ...............................
2.	I E Code Number	:	...................................
3.	Application for SEH/ISEH/ISSEH/ISSEH	:	..................................... .................................
4.	Branches (In India/Abroad)	:	...................................

S.No.	Name of the Place/ Country	Code

5.	Statement of gross foreign exchange earning direct and indirect sources (Licensing year wise):

Licensing year	Category of service provider	Description of services provided	gross foreign exchange earnings (direct and indirect sources)
(1)	(2)	(3)	(4)

DECLARATION

1. I/We hereby declare that this application is based on the foreign exchange earning direct and indirect of the preceeding three licensing years/ current licensing year on gross foreign exchange.

(Above S. No. 1. has been amended vide PN No. 53/2002-07, Dt. 31/12/2002)

[OLD-
1. I/We hereby declare that this application is based on the foreign exchange earning direct and indirect of the preceeding three licensing years/ preceeding licensing year on gross foreign exchange. ]

2. I/ We further certify that I/ We am/ are authorised to verify and sign the statement on behalf of the applicant.

3. I/ We fully understand that any information furnished in the above statement, if proved incorrect or false, will render me/us liable to face any penal action or other consequences as may be prescribed in law or otherwise warranted.

4. I/We further declare that I/We has/have not applied nor obtained any recognition certificate as status holder from any other authority.

Signature	:.............................
Name in Block Letters	:.............................
Designation	:.............................
Place	:.............................
Date .........           Full Official Address	:.............................
Residential Address	:.............................
E.Mail address	:.............................

Official Stamp/ Seal

CERTIFICATE OF CHARTERED ACCOUNTANT/COST AND WORKS ACCOUNTANT/ COMPANY SECRETARY

I/We hereby confirm that I/We have examined the prescribed registers and also the relevant records of M/s................. for the licensing period(s) ..... and hereby certify that :

i) M/s............................... (full name and address of the applicant) have earned foreign exchange earning direct and indirect sources each of the three preceding licensing years/during the current licensing year as specified in the statement of exports at Sl.No.7.

(Above S. No.(i) has been amended vide PN No. 53/2002-07, Dt. 31/12/2002)

[OLD -
i) M/s............................... (full name and address of the applicant) have earned foreign exchange earning direct and indirect sources each of the three preceding licensing years/during the preceding licensing year as specified in the statement of exports at Sl.No.7. ]

ii) The following documents/records have been furnished by the applicant and their above mentioned subsidiary company and have been examined and verified by me/us namely: Bank Certificate of direct foreign exchange earning, FIRCs, certificate from international credit card companies etc. and C.A certificate for the indirect sources.

iii) The relevant register has been authenticated under my/our seal/signature.

iv) The financial information given in the above statement is in agreement with the relevant register and records; the same has been incorporated in the books of accounts maintained by M/s................... and their above mentioned subsidiaries; and is also true and correct.

v) It has been ensured that the information furnished is true and correct in all respect; no part of it is false or misleading and no relevant information has been concealed or withheld;

vi) Neither I, nor any of my partners is a partner, director, or an employee of the above-named entity or its associated concerns;

vii) I/we fully understand that any statement made in this certificate, if proved incorrect or false, will render me/us liable to face any penal action or other consequences as may be prescribed in law or otherwise warranted.

viii) I/ We verify that in case the status of Export House is being claimed under the reduced export performance criteria of Rs. 5 crores average FOB/ FOR in the preceding three licencing years, the exports have been made by * (a)Units in Small Scale Industry/ (b) Tiny Sector/ (c)Cottage Sector or (d)Units registered with KVICs or (e)KVIBs or (f)Units located in North Eastern States, (g) Sikkim and (h)J&K or Units exporting (i) handloom, (j) handicrafts, (k) hand knotted carpets, (l)silk carpets or (m)exporters holding golden status or (n)exporters exporting to countries in Latin America and (o) CIS/ (p)sub Saharan Africa or (q)Units having ISO 9000 (series) status or (r)service exporters or (s) agri exporters (other than grains).

(* Strike out whichever are not applicable)

(S.No. viii) has been added vide PN. No. 26/2002-07, Dt. 01/08/2002)

						Signature.............................
Place..........                          			Tel.No.  ............................                                   


                                                   			Official     
Date...........                             			Stamp/ Seal

Regn. No. and Date of the
Corporate Membership..........

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Documents to be enclosed with the application form:

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1. Self certified copy of a)project approval or b) classification approval of Department of Tourism or c)Any other registration. However, for Hotels, RCMC from FIEO is acceptable.

2. A certificate from Chartered Accountant/Cost and Works Accountant certifying the export/import performance in the prescribed format.

3. Copy of the FIRC issued by the Bank in respect of foreign exchange received from service rendered. This would not be applicable to the Hotel Industry.

4. Copy of the balance sheet filed with Income Tax Authorities for the relevant year or CA certificate from the statutory authorities.

(In above Appendix some words and expression has been substituted vide PN No. 17/2002, Dt. 05/06/2002)