APPENDIX - 9

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APPLICATION FORM FOR GRANT OF LICENCES FOR CAPITAL GOODS INCLUDING COMPUTER, COMPUTER SUB-SYSTEMS AND SERVICE EQUIPMENT UNDER THE EPCG SCHEME

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Note:

1. Please see paragraph 5.2 of this Handbook.
   
   
2. Please read the general instructions given at Appendix-1 before filling this application.
   
   
3. Please submit 10 copies of this application form.

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FOR OFFICIAL USE

File Number:........................

Date:........

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1.	Name and address of the applicant	:M/s....................................
2.	IEC Number	:...................
3.	Please tick the appropriate column :
	(i) Manufacturer Exporter	:
	(ii) Merchant Exporter	:
	(iii) Service Provider	:

4.	Capital investment on fixed assets :
			Existing	Proposed
	A.	Land and Building	Rs...........	Rs...........
	B.	Machinery/Equipments
		(i) Imported (CIF Value)	Rs...........	Rs...........
		(ii) Indigenous	Rs...........	Rs...........
		(iii) CIF value of CG applied for	Rs...........	Rs...........
		(iv) Total of (i)+(ii)+(iii)	Rs...........	Rs...........
		Total :	Rs...........	Rs...........
5	Any change in the status of SSI limit due to import of capital goods proposed to be imported under this scheme:		(a) Not applicable [ ] (b) No change [ ] (c) Crosses SSI limit [ ]
6.	i)	Name of the applicant or his supporting manufacturer(s)/ vendor(s). SSI/IEM NO. Dated Issuing Authority	:	......................................... ......................................... ......................................... ......................................... .........................................
	ii)	Address of factory where the capital goods to be imported are proposed to be installed	:	......................................... ......................................... .........................................
	iii)	The manufacturing products endorsed on SSI/Industrial Licence/IEM.	:
	iv)	Whether any export obligation has been imposed in the Letter of Intent/ Industrial Licence/ FC Approval.	:	Yes/No.
	If yes, give details thereof including E.O fulfilled, if any.		:
7.	(i)	Name of the end products to be manufactured out of the proposed capital goods.
	(ii)	Product(s) to be exported :
	(iii)	Export Product Group Code :
8.	Category of service provider (If applicable) Regd.No. ................... Dated ................... Issuing authority ...................		: [ ]
9.	(i)	CIF Value of the licence: applied for.	(In Rupees)............ (In freely convertible currency) .............
	(ii)	Export obligation under taken:
		(In freely convertible currency)	.....................
10.	Details of Fee		Bank Receipt/DD No.............. and date:...................... Amount Rs. .................... Name of the Bank and........................ Branch of issue ...................
11.	Details of exports made for the same on similar export product during preceding three licensing years.

LICENSING YEAR	FOB VALUE OF EXPORTS (in Rupees)	PRODUCTS EXPORTED
[1]	[2]	[3]

12.	Total customs duty on capital goods to be imported (in Rs.)	Duty leviable under EPCG scheme (in Rs.)	Duty saved (in Rs.)

13.	Details of EPCG Licences already obtained which have not been redeemed:

S.No.	Licence No. and date	CIF value(In Rupees)	Export obligation fixed in freely convertible currency	Whether BG/ LUT executed	%age of export obligation fulfilled
(1)	(2)	(3)	(4)	(5)	(6)

14.	Details of capital goods applied for import :

S.No.	Description and technical specification of the items of import	Quantity	CIF value in freely convertible currency	Country of origin
(1)	(2)	(3)	(4)	(5)

DECLARATION/UNDERTAKING

I/We hereby solemnly undertake/declare that:-

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 full 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. That I/We shall be liable to penal action in accordance with the Policy/Procedure/Foreign Trade (Development & Regulation) Act, 1992 the Rules and Orders framed thereunder and the Customs Act, 1962 addition to forfeiture of Bank Guarantee or any other Bond/Guarantee given to the Customs/licensing authority, in the event of failure to fulfill the export obligation as stipulated, within the export obligation period prescribed or subsequently extended by the competent authority.
   
   
5. I/We further declare that no export proceeds are outstanding beyond the prescribed period as laid down by the RBI, or such extended period for which RBI permission has been obtained.
   
   
6. I hereby certify that I am authorised to verify and sign this declaration as per paragraph 9.9 of the policy.

	Signature of the Applicant:.............
	Name: .................
	Designation: .................
	Official Address: .................
	.................
Place :	Residential Address: .................
Date :	.................
	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. Deleted

(Sl. No. 2. has been deleted vide PN. No. 39/2002-07, Dt. 08/10/2002)

[OLD - 2. Self certified copy of the Performa invoice/quotations of the foreign supplier showing the CIF value quoted. In case the Proforma invoice is on FOB basis, the applicant shall indicate the freight and insurance separately on its letter head. ]

3. Manufacturers illustrated pamphlets/catalogue/drawing/technical design etc.

4. Statement of exports achieved by the applicant in respect of the same/similar export product/services rendered during the preceeding three licensing years duly certified by a Chartered Accountant/ Cost and Works Accountant in the form given in Appendix-23/23A.

5. Registration certificate with the Service Tax Authorities. However this is applicable only for service providers.

(Pl. refer Cir. No. 10/2002-07, Dt. 01/08/2002 for Registration Certificate from Service Tax Authorities for Service Providers under EPCG Scheme)

(S.No 5 to the list of “Documents to be enclosed with the application form:” in Appendix 9 has been added vide PN. No. 12(RE-02), Dt. 2/5/2002)