APPENDIX - 11E
APPLICATION FORM FOR OFFSETTING OF OBLIGATION UNDER DUTY ENTITLEMENT PASS BOOK (DEPB) ON PRE EXPORT BASIS
Note:
1. Please see Paragraph 7.46 of the Handbook(RE-99).
2. Please read the general instructions given Appendix 1 before filling this application.
3. Please submit 2 copies of this application form.
FOR OFFICIAL USE
File No. Date: ...............
1. Name and address : ............................................
of the Applicant : ...........................................
2. IEC Number : ............................................
3. Total FOB value of :In figures Rs. ..............................
Exports realised :In words Rs. ..............................
4. Total DEPB entitlement claimed
(in Rs.) : In figures Rs. .............................
: In words Rs. .............................
5. Details of exports made
| S.No | S/Bill No and Date | FOB value as per Shipping Bill | Customs House | Bank Certificate No. and date |
| (1) | (2) | (3) | (4) | (5) |
| | | | | |
| Product group Code No. | Sl.No. of DEPB rate list (App.28A) | Description as per S/Bill | FOB as per Bank Certificate | DEPB Rate | Value of DEPB earned(Rs.) |
| (6) | (7) | (8) | (9) | (10) | (11) |
| | | | | | |
Total: .....................................................................
Note: For Product Group Code No. refer to Appendix-1.
6. DEPB already claimed on pre export basis
| S.No | File No and name of licensing authority | Value ( Rs.) | DEPB No. and date |
| [1] | [2] | [3] | [4] |
| | | | |
7. Balance value for which DEPB is to be issued : Rs..........................................
OR
Balance value of DEPB on which duty ............................................
and interest is payable.
8. Application fee for balance DEPB: : ............................................
Bank Receipt/DD No. and date : ............................................
Issued by: : ............................................
DECLARATION/UNDERTAKING
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 hereby declare that no DEPB has been claimed earlier pertaining to the particulars of the shipping
bills given above.
5 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.
6 I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 3.8 of
the Policy.
7 I/We further declare that in case of non realisation of export proceeds or lesser realisation of export
proceeds, we shall pay, in cash, an amount equivalent to the duty free import benefits availed
against DEPB entitlement already obtained on the non realised or lesser realised value of export
proceeds together with 24% interest reckoned from the date of duty free imports to the date of
payment (Applicable only in case of exports made against irrevocable Letter of Credit).
Signature of the Applicant:..............
Name: .................
Designation: .................
Official Address: .................
Tele.No : .................
Place :
Date : E-Mail Address :...............
Documents to be enclosed with the application form:
1. Bank Receipt (in duplicate)/Demand Draft evidencing payment of application fee in terms of
Appendix-34.
2. E.P Copy of DEPB shipping Bills.
3. Bank Certificate of Exports and Realisation in Appendix- 25.