APPENDIX- 10D

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STATEMENT OF FOREIGN EXCHANGE EARNINGS AND REDEMPTION FORM UNDER EPCG SCHEME FOR SERVICE PROVIDERS

a)	Name & Address of the Licence holder		:
b)	EPCG Licence No. & Date			:
c)	CIF Value					i)   Allowed:
						ii)   Utilised:

d)	Export Obligation imposed on the EPCG Licence

	i)	Export obligation  equal to four/five
		/ six times of the CIF value of 
		capital goods.

	ii)	Average exports to be maintained          
	::

e)	Type of service rendered  as per the 
	conditions attached to the EPCG licence	:

f)	Date of completion of export obligation	:

g)	Details of Service Provided            		:

	i)	Year/Block of year from the date 
		of issue of licence			:
	ii)	Proportion of total Export Obligation 
		fulfilled				:	::
	iii)   	Details				:

We hereby declare that the above particulars are correct
Signature with seal and

Designation of the service provider 

It is certified that we have verified the foreign exchange earned for the  licensing years mentioned above by the 
service provider.


Signature with seal of the

Chartered Accountant 

Membership No.

This is certified that all services rendered as shown above are in freely convertible currency (both direct and 
indirect in respect of the service provider) and payment of the same has been realised. 


Signature with the seal of the 
Bank/authorised dealer in foreign exchange.


Date:............						Bank/Authorised dealer  Code No...................

Note:	1.	The consolidated statement may be submitted only at the time of seeking redemption of Bank 
		Guarantee/Legal Undertaking and the statement should be complete in all respects including 
		the information in column (g)(3) above duly certified by Chartered Accountant as well as by 
		the Bank/authorised dealer.

	2.	For hotel industry, the payments covered under Policy circular 60/97-2002 dated 24.12.98, 
		shall be considered as foreign exchange earned for the purpose of EPCG scheme.
				
				Documents to be enclosed with the application form:

1. 	Copy of bill of entry showing date of clearance of the first consignment.