APPENDIX - 10H

DATA SHEET FOR FUEL RATE

Note: Please see paragraph 4.9 of the Handbook of Procedures (Vol 1) .

1. Name and address of applicant:	………………………………………………………………………………… …………………………………………………………………………………
2. I.E. Code No:	…………………………………………………………………………………

3. Item(s) of Export for which fixation of fuel rate is sought

S.No	Description of Item(s) of Export	S. No in Handbook, Vol 2

4. Exports made during past one year of items(s) for which Fuel rate is applied for:

S.No	Shipping Bill No	Description of Exports	Total Quantity (by weight)	Total FOB Value	Fob Value per kg

5. Units (KWH) of Electricity consumed for producing one kg of export product	………………………………………………………………………
6. Type of Fuel stipulated in permission issued by competent authority for installation of Captive Power Plant	………………………………………………………………………
7. Cost of Fuel per kg of export product	………………………………………………………………………

DECLARATION/UNDERTAKING

a) I/We hereby declare that the particulars and the statements made in this application are true and correct to the best of my /our knowledge and belief and nothing has been concealed or held therefrom.

b) I/We fully understand that any information furnished in the application if proved incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.

c) I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, the Rules and Orders framed thereunder, the Export and Import Policy and the Handbook of Procedures.

d) I/We hereby declare that I/we have submitted a copy of the data sheet and supporting documents to ______Export Promotion Council/Commodity Board on ______(Date).

e) I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 9.9 of the Policy.

(SIGNATURE OF APPLICANT)
Name in Block Letters
Designation

Official address                                
Place : 
Date :						Residential address   
							E-mail 

DOCUMENTS TO BE ENCLOSED WITH APPLICATION FORM
a) Appendix 2 of Handbook (Vol.1) alongwith the data sheet in duplicate.

b) Copy of permission issued by the competent authority under Section 44 of the Electricity Supply (Act), 1948 for installation of Captive Power Plant stipulating among other things, the specific fuel to be used by such plant.

(This Appendix added vide PN No. 18/2002, Dt. 14/06/2002)