APPENDIX - 1A

PROFILE OF EXPORTER/ IMPORTER

FOR OFFICIAL USE

File No:---------------------------------

Date:-----------------

Note:

To be submitted once alongwith the first application and to be submitted subsequently only in case of any change in the information already submitted.

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1.	Name of the applicant	......................................
2.	Address of the applicant (Registered Office in case of limited companies, and Head Office for others )	...................................... ...................................... ...................................... ......................................
		Tele No.:........................... Fax No :........................... E.Mail address: ...................
3.	Date of establishment of business/factory in India	cccccccc    d   d  m  m  y  y  y  y
4.	IEC No. .....................Date of Issue ..................... Issuing Authority ......................
5A.	(1) Merchant Exporter (2) Manufacturer Exporter(3)Service provider (4) Others (please specify)............................................ (5) Merchant cum Manufacturer
5B.	Status Code [ ] (as per S.No.7(b) of Appendix-1 of general instructions)
6.	Permanent Account Number (PAN) of Income Tax .................... Issuing Authority .....................................................

7.	Category of manufacturing licence	Number	Date	Issuing authority
	SSI Registration
	Industrial licence/ IEM
	Others (specify)

8	EH/TH/STH/SSTH/Golden status Certificate	No. .................................. Date: ................................ Valid upto: ..........................
8(a)	SEH/ISEH/ISSEH/ISSEH Certificate	No. .................................. Date: ................................ Valid upto:...........................
9.	Nature of the applicant firm:	......................................
	[1] Government undertaking [3] Private Limited Company [5] Partnership	[2] Public Limited Company [4] Proprietorship [6] Others (please specify)
10.	Details of the main Banker and Bank Account	Name of the Bank .............. Account No. ................... Type of Account ............... Address........................
11.	RCMC No. .................... Valid upto ...................	Date of Issue ................... Issuing Authority ...............
12.	Details of Proprietor / Partner(s)/ Director(s)/Karta to be given in the following manner:
	(1) (a) Name	......................................
	(b) Father"s Name	......................................
	(c) Residential address	......................................
	(d) E. Mail address	......................................
	(e) Telephone	......................................
(NOTE):Attach extra sheet wherever required)

Place: .......	Signature of the Proprietor/Partner(s)/Director(s)/Karta .........................
Date:.........	Name ......................... Designation ........................

(Pl. see Trade Notice No. 06, Dt.18/07/2001.)

(Pl. refer P.N. No. 46(RE-01), Dt. 5/11/2001, Regarding Quantity of 2000 Mts of "Sandalwood Chip Classes" for the export of the licensing year 2001-2002 with conditions and procedures )

(Pl. refer P.N. No. 47(RE-01), Dt. 5/11/2001, Regarding Quantitative ceiling for the export of Sandalwood Oil for the financial year 2001-2002 with procedure )

(Pl. refer Public Notice No.71(RE-01), Dt.22/02/2002 for Certification of Export Performance of units in the Pharma and Biotechnology sectors)