APPENDIX - 10D

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APPLICATION FORM FOR GRANT OF DUTY FREE REPLENISHMENT CERTIFICATE

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1. Please see paragraph 4.2 of the Policy and Paragraph 4.33 to 4.36 of this Handbook.

2. Please read the general instructions given at Appendix-1 before filling this application.

3. Please submit 2 copies of this application.

FOR OFFICIAL USE
File Number:---------------------------------------------------- Date:--------------------------------------

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1.	Name and address of the applicant	: .......................................
2.	I.E. Code No.:	: .......................................
3.	Export Product Group:	: .......................................
4.	S.No(s) of Standard Input-Output Norms or wastage norms as per 4.56 of Handbook for exports of gold/ silver/ platinum jewellery and articles thereof:	: .......................................

5.	Total FOB/ FOR value realised (including commission)	Rs.............. In currency ........... in US$ ...............of exports
6.	Total CIF value of imports:	Rs. ............ in currency ........... in US $ ...................of exports
7.	Value addition:

8.	Application fee	a) Bank Receipt/ Demand Draft No. and date	: ..................................... .......................................
		b) Rupees:	: ..................................... .......................................
		c)Issued by :	: ..................................... .......................................

9. Port of registration.	: .......................................
10. Details of the product exported/ deemed supplies made (Resultant Products).

S.No.	Resultant product			Total quantity	Unit of measurement		FOB/ FOR value
	Description of export/ supplied product	S.No. of SION	ITC(HS) Code		Name	Code	In rupees	In freely convertible currency (FCC) ( if applicable)

11. Details of Items sought to be imported Duty free as replenishment.

S.No	Import item		Technical Characteristics (for sensitive items as per paragraph 4.31)	Total quantity	Unit of measurement (U/M)
	Description	ITC(HS) Code			Name	Code

12. Details of other materials used in resultant product and imported/ procured from sources other than the licence.

S.No	Resultant product(s)(description of export product)	Total quantity	Imported item			Indigenously procured item
			Description	Quantity and U/M	CIF value	Description	Quantity and U/M	Value

DECLARATION/UNDERTAKING

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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 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.

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

Place :
Date :

Signature of the Applicant: ........................
Name: ........................
Designation: ........................
Official Address: ........................
........................
Tele No: ........................
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. Proof of Export/ Supplies:

(a) For physical exports an EP copy of the Shipping Bill or Bill of Export( Only in case of exports through notified land Customs and SEZs under paragraph 4.19).

(b) Incase of deemed exports, a copy of the invoice duly signed by the unit receiving the material and their jurisdictional excise authorities certifying the item of supply, its quantity, value and date of such supply. However, incase of supply of items, which are non-excisable product(s), a project authority certificate (PAC) certifying quantity, value and date of such supply would be acceptable in lieu of excise certification. Not withstanding the above, in respect of supplies to EOU, a copy of ARE-3 duly signed by the jurisdictional excise authorities certifying the item of supply, its quantity, value and date of such supply shall be furnished.

(Sl.No.2. has been amended vide PN NO. 47/2004, DT. 18/01/2005)

[OLD-
2. A) For physical exports an EP copy of the Shipping Bill or Bill of Export (only in case of exports through through notified land Customs under paragraph 4.19).

B) In case of deemed exports a copy of the invoice duly signed by the unit receiving the material and their jurisdictional excise authorities certifying the item of supply, its quantity, value and date of such supply. However in case of supply of items which are non excisable or supply of excisable items to a unit producing non excisable product(s), a project authority certificate (PAC) certifying quantity, value and date of supply would be acceptable in lieu of excise certification. Notwithstanding the above, in respect of supplies to EOU/SEZ, a copy of ARE-3 duly signed by the jurisdictional excise authorities certifying the item of supply, its quantity, value and date of such supply shall be furnished.]

3. Proof of export/ deemed supply proceeds realisation:

a) For Physical Exports: Bank Certificate of Exports and Realisation as given in Appendix 22 or Foreign Inward Remittance Certificate (FIRC) in the case of direct negotiation of documents or Appendix 22B in the case of offsetting of export proceeds with approval of RBI. In case of FIRC, a declaration from the exporter that the remittance is in respect of Shipping Bill(s) No ____________ dtd _________ shall also be furnished

b) For Deemed Supplies: Payment certificate from the project authority as per Appendix-12A or a payment certificate or bank certificate of payment for domestic supplies as per appendix-22A whichever is applicable.

4. A statement of exports/supplies giving separately each Shipping Bill number /supply Invoice number and date, FOB/FOR value in Indian rupees as per Shipping Bill/Invoice and description of the resultant product

5. In cases where import of fuel has been sought for the grant of DFRC , the applicant would be required to submit the following additional documents:

(a) Copy of the permission issued to the manufacturer exporter by the competent authority (concerned State Electricity Board or Power Corporation or Regulatory Commission of the concerned State) under Section 44 of the Electricity (Supply) Act, 1948 for the installation of captive power plant based on the specified fuel unless the permission is specifically waived by the State Electricity Board.

b) Copy of the letter intimating the date of commissioning of the Captive Power Plant to the concerned authority which issued the permission letter.

Note: The import of only such fuel(s) shall be allowed which have/ has been specified in the said permission.

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