APPENDIX - 5

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APPLICATION FOR REFUND OF APPLICATION FEE

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File  No. .................  .                    						Date ............. 

1. 	Category  under  which  refund  of application  fee  is  being claimed:
	(Please tick)
                                               
       	i) Deposited in excess of the specified scale          			.................... 
  
       	ii) Deposited in error but the applicant is            			....................
           	    exempt from payment of fee  

       	iii) Deposited but no application has been made        			....................
  
 2. 	In  case the refund is claimed under category 1 (i) above  the following details may be furnished:  

	i)  File No		:.............................................................................................. 

	 ii) Licence No. and date in..................................................................................... 
     	    case the same has been issued : 

 	iii)CIF value of the licence applied for 	:Rs................................................................. 

  	iv) Scale of the fee prescribed :............................................................................. 

   	v)  Fee payable at the prescribed scale : Rs.............................................................

  	vi) Fee paid :Rs..................................................................................................  

 	vii) Excess fee paid for which refund is claimed Rs.....................................................  

 3. 	In case the refund is claimed under category 1 (ii) above, the following details be furnished:  

       	i)  File No		: ........................................................................................... 

      	ii)  Licence  No. and date in ................................................................................. 
                 case the same has been issued: 

      	iii)  CIF value of the licence applied for :Rs.............................................................. 

       	iv) Provision  under  which  the  exemption  is  being  claimed: 
          	     (Please, specify only one of the five category as given in clause 5 (3) of Foreign Trade 
	     (Regulation) Rules, 1992) 
                  ................................................................................................................. 

 4.   	In  case  the  refund is claimed under the  category  1  (iii) above,  the 	................................  
      	reasons  for  not  making  an application  after  depositing the fee:		................................   

 5.       	i)  No.   and date of the Bank Receipt / Demand Draft by   which		................................
                 the application fee has been  deposited  				................................

          	ii) Name and Address of the Bank  					.................................  
              where the said fee was deposited 					................................. 

 6. 	Licensing  Authority  with  whom the  					.................................  
             application  has  been filed / was    					.................................  
             proposed to be filed: 

 7.       	i)  Has  this  application been filed  					.................................
                 within one year  of  the deposit of 					.................................  
                 the fee:  

         	ii)  If not, the detail reasons      					................................ 
                 thereof:  

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 hereby certify that I am authorised to verify and sign this declaration as per Paragraph 3.8 of the Policy.

Place :                   						Signature of the Applicant:.............
Date  :

Name: ................
Designation: ................
Official Address: ................
................
Tele.No.: ................
Residential Address: ..............
................
E. Mail address : ................

1. Exporter"s copy of the Bank Receipt against which the refund is being claimed.