Note: 1. Please see Paragraph 12.12B, 15.7 of the Policy and Paragraph 12.2 of this Handbook. 2. Please read the general instruction given at Appendix 1 before filling this 3. In addition to 2 copies of this application form. -------------------------------------------------------------------------- FOR OFFICIAL USE File No.:-------------------------------- Date:---------------------------- --------------------------------------------------------------------------- ------------------------------------------------- 1. Name and address : 2. I E Code Number : 2(A) PAN Number : 3. Application for : SEH/ISEH/ISSEH/ISSEH 4. Branches (In India/Abroad) :

S.No.	Name of the Place/Country	Code

PART - I 7. Statement of gross foreign exchange earning direct and indirect sources (Licensing year wise): (applicable for FOB criterion only)

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

PART - II 8. Statement of net foreign exchange earnings direct and indirect sources (Licensing yearwise) (applicable for NFE criterion only)

Licensing year	Category of service provider Description of service rendered.	Gross value in free foreign exchange earning (direct and indirect sources)	CIF value of all licences issued (licensing year wise) except EPCG licenses, Special Import Licence and	licenses surrendered within the period of validity.	NFE earning yearwise(direct and indirect sources)(col.4-5)
(1)	(2)	(3)	(4)	(5)	(6)

            

     				
-----------------------------------------------------------------------------------------
				DECLARATION 
     				----------- 

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

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

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. 

I/We further declare that I/We has/have not applied nor obtained any recognition
certificate as Export House/Trading House/ Star Trading House/Super Star Trading House
from any other authority. 

					Signature____________________________

					Name in Block Letters_________________ 

					Designation___________________________ 

					Place___________  

Date____________   Full Official Address__________ 
  

						Official  
					   Stamp/ Seal Full  
  
  

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 ................................and (applicable for gross foreign exchange 
 earnings) FOB criterion only) namely 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 net foreign exchange (direct and indirect sources)has been arrived at by
 deducting the following from the gross value of foreign exchange earnings
 (direct and indirect sources): (applicable for NFE criterion only)

 CIF value of all licences issued (licensing yearwise) except EPCG licences,
 Special Import Licence and licences surrendered within the period of their
 validity

 To this effect, I/We have examined and verified all the relevant documents like
 import licences, Bills of Entry, invoices, letters of credit etc."

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

v.  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. 

vi.  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; 

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

viii.  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.

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

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

Regn. No. and Date of the

Corporate Membership..........

----------------------------------------------------------------------------
Documents to be enclosed with the application form: 
----------------------------------------------------------------------------
1.  Self certified copy of (a) project approval or (b) classification approval of
 Department of Tourism (c) Any other registration.

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

3.  Self declaration regarding irrevocable option to claim the benefit either on  
 gross value foreign exchange earnings, direct and indirect sources, FOB or on  
 NFE, direct and indirect sources basis.

4. Copy of the FIRC issued by the bank in respect of foreign exchange received
 from service rendered. 

5. Copy of the balance sheet filed with Income Tax Authorities for the relevant
 year.