APPENDIX -9 C

APPLICATION FORM FOR CLUBBING OF LICENCES UNDER THE EPCG SCHEME

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Note: 1. Please see paragraph 5.18 of this Handbook.

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FOR OFFICIAL USE

File No...........................

Date.........................

1. Name and address of the applicant	: M/s...................................................
2. IEC Number	:

3. Details of EPCG licences presented for clubbing:

S. No	EPCG Licence No	Date of Issue	Export Product(s)	Capital Goods applied for import	Port of Regd
(1)	(2)	(3)	(4)	(5)	(6)

CIF Value permitted	CIF value of imports made	Customs Duty Saved	Export obligation fixed (in US $)	Exports actually made (In US $)
(7)	(8)	(9)	(10)	(11)
		Total:	Total:

4: Details of clubbed licence

10.	(i) Total Duty saved or CIF value on the imports/ deemed imports (as per column 7 or 8 in the table above	: (In FFC)…………………………………………………. : (In Rupees)…………………………………………..
	(ii) Total Export obligation (as per column 9 in table above)	: (In FFC)…………………………………………………. : (In Rupees) ………………………………………..

DECLARATION/UNDERTAKING

I/We hereby solemnly undertake/declare that:-

(i) I/We hereby declare that the particulars and the statements made in this application for clubbing are true and correct to the best of my/our knowledge and belief and nothing has been concealed or held therefrom.

(ii) 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.

(iii) I/We further declare that the clubbing is being sought for EPCG licences issued in the same licencing year, having the same export product(s) or services, issued under the same Customs Notification and having the same port of registration.

(iv) 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.

(v) 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.

(vi) 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 : _______________
Date : _______________

Residential Address : ____________________________
____________________________
____________________________
E-mail address: ____________________________

(Above Appendix - 9C has been added vide PN. No. 42/2003, DT. 28/01/2004)

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