Note: 1. Please see paragraph 8.14 and 8.20 the Policy and Paragraph 8.54 and 8.57 of this Handbook. 2. Please read the general instructions given at Appendix 1 before filling this application. 3. In addition to this application form, please also submit Appendix-1 A (in duplicate) alongwith this application. ------------------------------------------------------------------------------------- FOR OFFICIAL USE File No. :------------------------- Date :---------------- ------------------------------------------------------------------------------------- Dated ________________________ This is certify that the following are the details of goods actually sold against invoice No.(s) ______________________ dated________________ in the exhibition and the foreign exchange repartiated into India and surrendered to the RBI / authorised dealer.The export has been in accordance with the Export and Import Policy, 1997-2002. 1. Name of the Indian Exporter 2. Exhibition held on (i) Date :From :.......... To :.............. (ii) Place 3. Organised by whom : 4. Details of Bank Guarantee, if any : 5. Price of gold / silver as per export invoice

Sl.No	Pieces	Decription	Gross Wt. Gms.	Net Wt. Gms.	Value of Gold/silver as per Rate booking for replenishment	Description/ type of Studding/Diamond/ precious semi-precious/synthetic stones/pearls	Pieces
1	2	3	4	5	6	7	8

Wt.In cts.	value of studdings	Actual sale price & date of sale	Making charges	Value i.e. at rate of Gold /silver at 6	Selling price in foreign currency	FOB Value repatriated	Value addition achieved with respect to value at 13
9	10	11	12	13	14	15	16

Signature : Name : Designation : Name of the Nominated agency : Place : Date : Seal :