APPENDIX - 20

PROFORMA FOR SUBMISSION OF GRIEVANCE REPRESENTATION

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NOTE: PLEASE SEE PARAGRAPH 9.9 OF THIS HANDBOOK

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FOR OFFICIAL USE

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

1.	Name of the Applicant	:...................................
2.	Address:	:...................................
3.	Grievance pertains to: (Please tick)	Details may be mentioned (use additional sheets, if required)
	EPCG Scheme	c
	Duty Exemption/Remission Scheme	c
	Diamond Gem & jewellery & jewellery Scheme	c
	Export Licence	c
	Import Licence	c
	Any other matter	: .................................
4.	Particulars of file/ correspondence Ref No./date of DGFT or its regional office, if any:	:...................................
	Whether the Grievance Committee of the concerned regional licensing office has been approachedif so, furnish particulars/ decision, if any, taken by such a Committee.	Yes [ ] No. [ ] :...................................
6.	Any other remarks	:...................................

                                        		Signature

                                        		Name in Block Letters :......................

                                        		Designation : ...............................

                                        		Telephone : .................................

					E-Mail address	:...........................
                              			Fax:	:...........................