APPENDIX - 58

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PROFORMA FOR FURNISHING OF EXPORT RETURNS

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Nont: Please see with paragraph 11.7 of Handbook (Vol.1)

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1.	Name of the firm/company			:

2. 	IEC number				:

3.	Address					:

4. 	Tel. No.					:

5. 	Fax no. 					:

6.	E-mail address				:

7. 	Website					:

8. 	Details of exports:				:

Period	Item(s)	Quantity, if applicable	country (s) of export (item wise)	Value of export during the period (in Rs.)	Cumulative exports (Apr 2001 onwards) (in Rs.)
[1]	[2]	[3]	[4]	[5]	[6]

Cumulative exports (in wards) :............................................................................................

DECLARATION

I/We hereby declare that the above statments are true and correct to the best of my/ our knowledge and belief.

Date
Signature
Name	Stamp
Designation
	seal/Stamp