APPENDIX-17E

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STATEMENT OF UTILISATION OF DUTY FREE CREDIT ENTITLEMENT FOR STATUS HOLDERS

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(Please see paragraph 3.7.2.1(vi) of the Policy and 3.2.5 of the Handbook)

Reference File Number under which duty free credit entitlement was issued		:...................................... ......................................
Date of issue of entitlement		: ......................................
1.	Name and address	:...................................... ...................................... ......................................
2.	I E Code Number	: ...................................
3.	Status	:Export House                  :[ ]  Trading House                  :[ ]  Star Trading House            :[ ]  Super Star Trading House   :[ ]
4.	Credit value of the Duty Free Credit Entitlement (in rupees lakhs)	:...................................... ......................................
5.	Credit value utilised (in rupees lakhs)	:
6.	Details of imports made under the duty free credit entitlement:

Sl.No.	Description of import item	Effective Customs duty (in %age)	Value debited (in rupees lakhs)
(1)	(2)	(3)	(4)
1. 2. 3. 4.

DECLARATION

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

2. 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.

3. I/We further declare that I/We has/have made imports against the duty entitlement certificate issued under paragraph 3.7.2.1(vi) of the Policy based on the exports in free foreign exchange during 2002-03 and 2003-04.

4. The imports made under the Duty Free Credit Entitlement number............. are those of capital goods/office equipment and inputs which are freely importable and which are required in my/our line of business.

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

Official Stamp/Seal

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