APPENDIX - 23

FORMAT OF CERTIFICATE OF CHARTERED ACCOUNTANT/ COST AND WORKS ACCOUNTANT

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I/We hereby confirm that I/We have examined the prescribed registers and also the relevant records of M/S________________ for the period ________ and hereby certify that:

(i) M/S._____________________ (full name and address of the applicant) have made the following exports in the preceding three licensing years:

Year ______

Export product ______________

FOB value ___________

(ii) The following documents/records have been furnished by the applicant and have been examined and verified by me/us namely :-

Export order/ Contract, shipping bills, Bill of Lading (and/ or Airways Bills/ Receipts). Customs/ Bank attested Invoices, Bank Certificates of exports showing exports made and export proceeds realised in freely convertible currency in their own name and connected books of accounts.

(iii) The relevant registers have been authenticated under my/ our seal/signature.

(iv) The financial information given in the above statement is in agreement with the relevant register and records; the same has been incorporated in the books of accounts maintained by the exporter; and is also true and correct.

(v) It has been ensured that the information furnished is true and correct in all respect; no part of it is false or misleading and no relevant information has been concealed or withheld;

(vi) Neither I, nor any of my partners/director is a partner, director, or an employee of the above-named entity or its associated concerns;

(vii) I/We fully understand that any statement made in this certificate, if proved incorrect or false, will render me/us liable for any penal or other consequences as may be prescribed in law or otherwise warranted.

(viii) I/ We certify that M/s ………………………… have made exports (directly or through third party) and has realized the foreign exchange in its own name or the third party as the case may be in the preceding three licencing years as per the details given in the annexure to this certificate.

(Signature and Stamp/Seal of the Signatory)

(Chartered Accountant/Cost & Works Accountant)

	Name of the Signatory :
Place:	Full Address :
Date:	Membership No. : Contact No. : E-mail :

If any of the documents or record mentioned in item (ii) of the certificate have not been maintained/ furnished, examined or verified, they may please be specified below:-

1.

2.

3.

Note: Wherever CA certificate has been specified in any paragraph of the Policy/Handbook (Vol.1), CA/Cost and Work Accountant Certificate may be furnished by the applicant as per the Performa given above.

Annexure to the Certificate of Chartered Accountant/ Cost and Works Accountant

S.No	Shipping Bills Nos	Date of Let Export	Description of product	FOB value (in rupees)

Note.

1. Each page of this annexure is to be signed by the Chartered Accountant with his registration number.

2. The annexure shall be required to be furnished only with the application for grant of One to Five Star Export House.

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