Note: Please see Paragraph 4.16, .6.15, 7.22 and 7.23 of this Handbook.
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FOR OFFICIAL USE
File No.:-------------------------------- Date:-----------------
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1.a) Name & address of the licensee : ..............................
.............................
b)IEC No. : ..............................
c)PAN Number :................................
2. (a) Licence No. & Date :..............................
(b) CIF value :.............................
(c) File No. of the Licensing Authority
from which the licence was issued. : ............................
3. Details of licence Utilisation of licence
| S.no |
Item |
Value |
Quantity |
Value |
In & value(4 as % of 2) |
In & value(6 as % of 3) |
| |
(1) |
(2) |
(3) |
(4) |
(5) |
(6) |
a.
b.
c.
|
|
|
|
|
|
|
| |
|
|
|
Total ......... |
|
| Export Obligation |
Export obligation completed(During initial period) |
Export obligation completed(During extended period) |
Unfulfiled Export obligation |
| S. No. |
Item | Value | Quantity |
Value terms (Rs./%) | Quantity terms (%) |
Value terms (Rs./%) | Quantity terms (%) |
Value terms (Rs./%) | Quantity terms (%) |
| | (1) | (2) | (3) | (4) | (5) |
(6) | (7) | (8) | (9) |
a.
b.
c. | | | | |
| | | | |
| | | | | Total........ |
| | | | |
3 (b).Extension in Export : ..............................
Obligation period applied
upto
4. Validity of Licence :
| Initial validity |
Extented validity |
Revalidaton applied upto |
| (1) |
(2) |
(3) |
|
|
|
5. Bank Receipt / Demand Draft No. ......................................
Date: .................
Value: .................
Issuing Bank- ................
Branch
6. Reasons for seeking revalidation / ...........................
Extension in export obligation period:
DECLARATION / UNDERTAKING
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1. 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.
2. 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.
3. 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.
4. I / We further declare that no export proceeds are outstanding
beyond the prescribed period as laid down by the RBI ,or such
extended period for which RBI permission has been obtained.
5. I hereby certify that I am authorised to verify and sign this
declaration as per Paragraph 3.8 of the Policy.
Place : Signature of the Applicant:..............
Date :
Name: .................
Designation: .................
Official Address: .................
.................
Tele.No.:
Residential Address: .................
.................
E-Mail Address : .................
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Documents to be enclosed with the application form
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1. Bank Receipt (in duplicate) / Demand Draft evidencing payment
of application fee in terms of Appendix-34 as applicable.
2. Import Licence in original and a self certified copy thereof.
3. DEEC Book (PartI) and (Part II) in original and a self
certified copy thereof the licence is under Duty Exemption
Scheme.