APPENDIX - 13

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APPLICATION FORM FOR GEM REPLENISHMENT AGAINST EXPORTS

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Note:

1. Please see Paragraph 4.4.1 and 4.4.13 of the Policy and Paragraph 4.58 and 4.80 of this Handbook.
   
   
2. Please read the general instructions given in Appendix-1 before filling this application.

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FOR OFFICIAL USE

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

.................................................................................................................................................

1. 	Name and address of Applicant         			:......................................
                                         
2. 	IEC Number                            			:......................................

3. 	Export proceeds realisation Month     			:......................................

4. 	Total FOB value of Exports (in figure)			: .....................................
   	(In free foreign exchange)/Rupee                                                                                     
                              				
5. 	Value of Licence claimed   				 : .....................................
   	(In free foreign exchange/Rupee)
                              				
6. 	Application Fee 			        		Rs......................................
   	Bank Receipt/Demand Draft No.         			: ........................date: ........
   	Name of the bank and issuing branch   		: ......................................

Name of the bank	S.No. in Shipping Bill/postal receipt	Date of export	Amount of exports proceeds realised	Country of exports	FOB value (in free foreign exchange)/ rupees	Value of the REP licence claimed
1 a b
2 a b
3 a b

(Note: The above stated table is not required to be filled up in case of an application for Replenishment licence under paragraph 4.80 of this Handbook)

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 declare that outstanding realisation of export proceeds beyond 180 days does not exceed 10% of average exports of preceding three licensing years. I/We further declare that no export proceeds are outstanding beyond the period of one year or such extended period for which RBI permission has been obtained.

5. I hereby certify that I am authorised to verify and sign his declaration as per Paragraph 9.9 of the Policy

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

Name: ..........................
Designation: ..........................
Official Address: .........................
...........................
Tel.No.: ..........................
Residential Address: ..........................
E.Mail Address: ..........................

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Documents to be enclosed with the application form:

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1. Bank Receipt (in duplicate)/Demand Draft evidencing payment of application fee in terms of Appendix-29.

2. Bank certificate of export and realisation in the form given in Appendix-22 evidencing realisation of exports proceeds/sales proceeds.

3. Export Promotion copy of shipping bill(s). (Photocopy of the EP copy of Shipping Bill duly endorsed may be returned for utilisation/re-import purposes when the exports are made on consignment basis).

4. Customs attested invoice

5. In case of application for Replenishment licence under paragraph 4.80 of this Handbook, an applicant will be required to submit documents as given at S.No.1 above and Statement of Exports made during the preceding year duly certified by Chartered Accountant/Cost & Works Accountant.