APPENDIX-10 J

APPLICATION FORM FOR DUTY ENTITLEMENT PASS BOOK (DEPB)

ON POST EXPORT BASIS FOR DTA SUPPLIES TO SEZ

Note :

1. Please see Paragraph ___________________ of this Handbook

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

3. Please submit 2 copies of this application form.

FOR OFFICIAL USE

File No. …………………………	Date ................……………….
IEC Number : ……………………………	Branch Code : ……………………………

1.	Name and address of the Applicant	: ………………………………………..
2.	FOR value of exports	: In figures : Rs. ……………………. In words : Rs. ……………………..
3.	Total DEPB entitlement claimed	: In figures : Rs. ……………………. In words : Rs. ………………………
4.	Application fee Bank receipt /EFT/DD No. Issued by	: Rs. …………………………………… Dated …..…………………………….
5.	Port of Registration	: …………………………………………
6.	Application for transferable DEPB	: Yes/No
7.	Details of exports made

S. No.	Bill of export No + Date + Port of Export	Date of examination of goods by Customs	Bank certificate Number + Date	Invoice No.	S. No. of Invoice	Product Group	DEPB S. No.	Item Description
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)

FOB In Free Foreign Exchange		Exchange Rate on the date of examination by Customs	Total FOB (In Rs.)	Computation of Capped Value
Currency Code	Value		[(11) * (12)]	Unit of Measurement (U/M) in the unit of value cap	Export Qty in U/M	Value Cap	FOB per U/M [(13)/(15)]	Capped value [minimum of (16) & (17)] or (17) as the case may be *
(10)	(11)	(12)	(13)	(14)	(15)	(16)	(17)	(18)

DEPB Rate (in %)	DEPB Entitlement (without cut) (15) * (18)* (19)/100	Cut Applicable if any (in %)	Actual DEPB Entitlement (20)*{1-[(21)/100]}
(19)	(20)	(21)	(22)

* In case there is no value cap on the product, the capped value would be equal to the FOB value per unit of measurement (U/M) as at column (17) of the table above. Else it would be the minimum of columns (16) and (17).

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 hereby declare that no DEPB has been claimed earlier pertaining to the particulars of the Bill of Export given above.

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.

7) I/We further declare that in case of non realisation of export proceeds or lesser realisation of export proceeds in free foreign exchange, we shall pay, in cash, an amount equivalent to the DEPB entitlement already obtained on the non realised or lesser realised value of export proceeds together with 15% interest reckoned from the date of duty free imports effected under DEPB to the date of payment.

Signature of the Applicant : ………………………………………..
Name : ………………………………………..
Designation: ………………………………………..
Official Address : ………………………………………..
………………………………………..
Tele No. : ………………………………………..
Residential address : ………………………………………..
E.Mail address : ………………………………………..

Date :
Place :

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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. Copy of Bill of export.

3. Bank Certificate as given in Appendix-22A.

4. Copy of Invoice

5. Copy of disclaimer certificate.

(Appendix 10 J has been added vide PN NO. 11/2003, DT. 30/05/2003)

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