APPENDIX-15A
APPLICATION FORM FOR GRANT OF EXPORT LICENCE FOR EXPORT OF SPECIAL CHEMICALS, ORGANISMS, MATERIALS, EQUIPMENTS AND TECHNOLOGIES (SCOMET) ITEMS MENTIONED AS RESTRICTED FOR EXPORT IN APPENDIX-3 SCHEDULE 2 OF ITC(HS) CLASSIFICATIONS OF EXPORT AND IMPORTS ITEMS
Note:
1. Please read the general instructions given at Appendix 1
before filling this application.
2. Please submit 5 copies of this application form.
FOR OFFICIAL USE
File No.:-------------------------------- Date:-----------------------
PART-I
1. Name and address of the Applicant :
2. IEC Number :
PART-II
(To be filled in for export of Special Chemicals in Categories 1B and 1C of Appendix-3)
3. (i) Item of export :
(ii) Quantity applied for :
(iii) FOB value per unit :
(iv) Total FOB Value :
4. Details of the exports of category 1B and 1C Items in
preceding three licensing years
|
S.No | Year | Name of the item | Licence no. and date | Qty & value in US$ of the licence | Qty & value in US$ of the item exported | Name of the end user | Country to which exported |
| [1] | [2] | [3] | [4] | [5] | [6] | [7] | [8] |
| | | | | | | | |
5. If applied for export on :
repeat basis in the same
licensing year for same
product and end-use and to
the same end-user, then
following information may
also be furnished
(i) Reference number and :
date vide which the
earlier permission was
granted by this office
(ii) Export licence number :
and date
(iii) Quantity allowed for :
export
(iv) Quantity exported on :
the date of this
application
6. Export Order No. & date :
(Attach copy)
7. Name and full address of the :
buyer
8. Name and full address of the :
end user
9. Port of shipment :
10. Destination of export
(i) Port of Discharge :
(ii) Ultimate Destination :
11. End product for which the :
item of export will be used
by the end user (attach end
user certificate)
12. The purpose for which the end :
product will be utilised
13. If application is for export :
of samples, furnish the
following details:
(i) Ceiling limit :
(ii) How much in excess of :
the ceiling limit
(iii) Justification for excess :
PART-III
(To be filled in for export of all other Category items of Appendix-3 except those covered by Part-II
above)
14. Category, item number and item :
name as in Schedule 2 Appendix 3
of ITC (HS) Classifications of Export
And Import items (Attach technical
specification not exceeding one
page for item, in the order in which
these items have been listed)
15. (i) Quantity applied for :
(ii) FOB value per unit (US $) :
(iii) Total FOB value (US $) :
16. Importer"s Purchase Order number :
and date (Attach copy)
17. Is the applicant the producer/ :
manufacturer of the item to be
exported? If not, name the producer/
manufacturer and provide full address,
telephone No. etc.
18. Details of Export Licences (EL) previously :
applied for items under Schedule 2
Appendix 3 of ITC(HS) (HS)Classifications
of Export and Import items
|
S.No. | Date of application | No. & date of export licence (see Note below) | Items exported & Qty-Value | Date of shipment (attached B/L copy) | Destination Country |
| [1] | [2] | [3] | [4] | [5] | [6] |
| | | | | | |
* State "denied", if the licence was denied. A false statement will invite prosecution.
19. Port of Shipment :
(Delhi, Mumbai, Calcutta or Chennai -
Identify only one Port)
20. Destination of Export (Country) :
21. Name of the consignee, complete :
postal address; telephone, fax etc.
22. Citizenship of consignee (if :
individual)
23. Headquarters address of consignee, :
if corporate office different from
entry at (10) above.
24. (a) Location (country) of end-user :
(b) End product and/or end- purpose :
for which the exported item will
be used by the end user. (Attach
end-use certificate in the
prescribed proforma)
(c) Name and complete address of :
end-user (include telephone,
fax Nos. etc.)
(d) Is end-user an entity of :
Government of destination
country?
(e) Manufacturing/Business/Other :
activity of the end user.
25. Through which banks will the
financial transactions relating to
this export be executed?
(a) In destination country :
(provide full address)
(b) In India :
26. Name and address of all foreign :
Collaborators of the applicant
(as registered with GOI/RBI).
If none, state None.
27. Period during which the item is :
proposed to be exported from India.
28. If revalidation required :
(a) Period of extension sought :
(b) Reasons therefor
DECLARATION/ UNDERTAKING
I/We solemnly declare/undertake that:-
(i) The particulars and the statements made in this application and attachments thereto are true to the best of my/our knowledge and belief, and nothing has been concealed or withheld therefrom.
(ii) If any information furnished in this application is
found to be false, inaccurate, not current or
misleading, any licence granted on the basis of this
application shall be liable to cancellation or being
made ineffective without prejudice to any other action
that may be taken in this behalf under the Foreign Trade
(Development and Regulation) Act, 1992, or rules and
orders made thereunder, and the Customs Act, 1962.
(iii) Any information furnished in this application if proved
incorrect, false, inaccurate, not current or misleading
will render me/us liable for any penal action or other
consequences as may be prescribed in law or otherwise
warranted.
(iv) I/We further declare that no export proceeds areOutstanding beyond the prescribed period as laid down by the RBI, or such extended period for which RBI permission has been obtained.
(v) I hereby certify that I am authorised to certify and Sign this declaration as per Paragraph 9.9 of the Policy.
(vi) I/We further undertake to submit to the DGFT (PC-III Section) a copy of the Bill of Entry into the destination State Party within 30 days of delivery failing which I/We shall be liable to action under the Foreign Trade (Development and Regulation) Act 1992, or Rules and Orders made thereunder and the Customs Acts, 1962.
Place:
Date :
Signature of the applicant ___________
Name in block letters _________________
Designation _________________
Official Address _________________
_________________
Residential
Address _________________
E.Mail Address _________________
Note: Each page of this application should be signed individually by the Managing Director, or the Company Secretary or a Director of the firm. If signed by a Director of the firm, then that Director must be duly authorised to do so by the Board of Directors of the firm.
This Certificate is to be furnished by the exporters of Categories 1B & 1C items of Appendix-3
END USE CERTIFICATE
(To be furnished with reference to S. No.11 of this Export Licence Application)
We, (name of the end user), certify that we are importing _________________ M.T. of____________ from (name and address of exporter) for the manufacture of ______________(state specific use)
We further certify that we will not use the above mentioned chemical for any purpose other than stated as above nor transfer or re-export the item to any other party/country for any other purpose.
Place: Signature of end-user with Stamp and Seal
Date: Name:
Designation:
Note:The exporter shall furnish a copy of confirmed export order indicating number and date to the
customs and DGFT at the time of actual shipment.
This Certificate is to be furnished by the exporters of all other category items (except categories 1B & 1C) of Appendix-3
END USE/END USER CERTIFICATE
[Read instructions at foot of page]
1. I/We _____________________________ a/ hereby certify that we
are the end-user of ________________________________ b/ to be
imported from ____________________________ c/ against our
Purchase Order No. ______________ dated __________ for the
manufacture of/used for __________________________ d/.
OR
The undersigned, hereby declares that I am duly authorised to
certify that _____________________________________________ a/
are the end-users of the items detailed in their Purchase
Order No. ____________ dated __________ and are importing the
said items from ___________________ c/ for the manufacture
of/used for ___________________ d/.
2. I/We further certify that the items detailed in the referenced
Purchase Order will not be used for any purpose other than the
purpose(s) stated in the Purchase Order, and that such use
will not be changed nor the items modified or replicated
without the prior consent e/ of the Government of India.
3. The end-user shall not himself, or through another, cause the
items, or replicas, or derivatives thereof to be
re-transferred/sold without the knowledge/consent e/ of the
Government of India, to any party within ________________ f/
or outside it.
4. I/We also certify that all the facts contained in this
certificate are true and correct to the best of my knowledge
and belief and that I/we do not know of any additional facts
that are inconsistent with this certificate.
Place:
__________________________________________
Date : Signature of end-user/authorised signatory
of end-user with stamp and seal
Name : ___________________________________
Designation : ____________________________
Instructions:
a/ Name of end-user as at entry 24(c) of this Export Licence
Application.
b/ Items entries as at Sl. No. 14 of this Application.
c/ Name and address of exporter in India.
d/ Name of the end product/end use.
e/ DGFT will state the condition in export licence. Do
not strike out.
f/ Destination country.