APPENDIX - 19B

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APPLICATION FOR GRANT OF SERVICE EXPORT HOUSE, INTERNATIONAL SERVICE EXPORT HOUSE, INTERNATIONAL STAR SERVICE EXPORT HOUSE, INTERNATIONAL SUPER STAR SERVICE EXPORT HOUSE

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Note: 

1.	Please see Paragraph 12.12B, 15.7 of the Policy and paragraph 12.2 of this Handbook.

2.	Please read the general instruction given at 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      	:

2. 	I E Code Number       	: 

3. 	Application for SEH/ISEH      : 
	/ISSEH/ISSEH

4. 	Branches (In India/Abroad) 	:

S.No.	Name of the Place/Country	Code

PART - I 7. Statement of gross foreign exchange earning direct and indirect sources (Licensing year wise): (applicable for FOB criterion only)

Licensing year	Category of service provider	Description of services provided	gross foreign exchange earnings (direct and indirect sources)
(1)	(2)	(3)	(4)

PART - II

8.  	Statement of net foreign exchange earnings direct and indirect sources (Licensing yearwise) 
	(applicable for NFE criterion only)

Licensing year	Category of service provider	Description of service rendered.	Gross value in free foreign exchange earning (direct and indirect sources)	CIF value of all licences issued (licensing year wise) except EPCG licenses and licenses surrendered within the period of validity.	NFE earning yearwise(direct and indirect sources)(col.4-5)
(1)	(2)	(3)	(4)	(5)	(6)

DECLARATION

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I/We hereby declare that this application is based on the foreign exchange earning direct and indirect of the preceeding three licensing years/ preceeding licensing year on gross foreign exchange /NFE basis.

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

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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.

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I/We further declare that I/We has/have not applied nor obtained any recognition certificate as status holder from any other authority.

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

CERTIFICATE OF CHARTERED ACCOUNTANT/COST AND WORKS ACCOUNTANT/ COMPANY SECRETARY I/We hereby confirm that I/We have examined the prescribed registers and also the relevant records of M/s...................................... for the licensing period(s) ............. and hereby certify that :

1. M/s ................................................... and (applicable for gross foreign exchange earnings) FOB criterion only) namely M/s............................ (full name and address of the applicant) have earned foreign exchange earning direct and indirect sources each of the three preceding licensing years/during the preceding licensing year as specified in the statement of exports at Sl.No.7.
   
   
2. The following documents/records have been furnished by the applicant and their above mentioned subsidiary company and have been examined and verified by me/us namely: Bank Certificate of direct foreign exchange earning, FIRCs, certificate from international credit card companies etc. and C.A certificate for the indirect sources.
   
   
3. The net foreign exchange (direct and indirect sources)has been arrived at by deducting the following from the gross value of foreign exchange earnings (direct and indirect sources): (applicable for NFE criterion only)
   
   CIF value of all licences issued (licensing yearwise) except EPCG licences and licences surrendered within the period of their validity
   
   To this effect, I/We have examined and verified all the relevant documents like import licences, Bills of Entry, invoices, letters of credit etc.’
   
   
4. The relevant register has been authenticated under my/our seal/signature.
   
   
5. The financial information given in the above statement is in agreement with the relevant register and records; the same has been incorporated in the books of accounts maintained by M/s........... and their above mentioned subsidiaries ; and is also true and correct.
   
   
6. It has been ensured that the information furnished is true and correct in all respect; no part of it is false or misleading and no relevant information has been concealed or withheld;
   
   
7. Neither I, nor any of my partners is a partner, director, or an employee of the above-named entity or its associated concerns;
   
   
8. I/we fully understand that any statement made in this certificate, 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.

								Signature.............................
Place..........                          					Tel.No.  ..............................

                                              						      Official
Date...........                             						   Stamp/ Seal

Regn. No. and Date of the
Corporate Membership..........

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Documents to be enclosed with the application form:

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1. Self certified copy of a) project approval or b) classification approval of the Department of Tourism or c) any other registration (in the case of the hotel industry, an RCMC from FIEO is acceptable)

2. A certificate from Chartered Accountant/ Cost and Works Accountant certifying the export/ import performance in the prescribed format.

3. Self declaration regarding irrevocable option to claim the benefit either on gross value of foreign exchange earnings, direct and indirect sources, FOB or on NFE, direct and indirect sources basis.

4. Copy of the FIRC issued by the Bank in respect of foreign exchange received for service rendered. However this would not be applicable to the Hotel Industry.

5. Copy of the balance sheet filed with the Income Tax Authorities for the relevant year/ CA certificate from the statutory authorities

("Documents to be enclosed with the application form:" has been amended vide PN. No. 44(RE-01), Dt. 31/10/2001.)