ANF 5B

Statement of Export/Redemption of EPCG Authorisation

1. IEC Details

i. IEC Number

ii. Date of Issue

iii. Issuing Authority

1. EPCG Authorisation Details
i a. EPCG Authorisation Number
I b. Date of Issue
ii. CIF Value/Duty saved value endorsed on the Authorisation
a. In Indian Rupees
b. In free foreign exchange
iii. Export Obligation imposed on the Authorisation
a. In Indian Rupees
b. In free foreign exchange
iv. Average Exports to be maintained
a. In Indian Rupees
v. CIF Value/ Duty saved value utilized
a. In Indian Rupees
b. In free foreign exchange
vi. Export Obligation wrt imports made under Authorisation
a. In Indian Rupees
b. In free foreign exchange
vii a Date of expiry of initial export obligation period
vii b. Date of expiry of extended export obligation period
Vii c. Date of completion of export obligation
viii. Product to be exported/Services rendered

2. Details of physical exports/deemed exports made/services rendered

S No	Products Exported/ Supplied/Services rendered	Shipping Bill/ Voucher/Invoice/ CT 3 / ARE 3/ Lorry Receipt/ Railway Receipt Details +		FOB / FOR value(in FFE/) ++
		No	Date	Direct exports	Third Party exports	Deemed Exports	Royalty payments	Forex for R &D Services	Total

+ not to be filled in by hotel industry

++ Only Exports/ Supplies made/ capable of being made/ services rendered out of capital goods imported under the Authorisation for discharge of export obligation imposed on the Authorisation and export proceeds realized to be included

3. Details of physical exports/deemed exports made/ services rendered for maintaining average exports under the EPCG Authorisation

Year	Products Exported/ Supplied	Shipping Bill/ Voucher/Invoice/ CT 3 /AR 3/ Lorry Receipt/ Railway Receipt Details *		FOB / FOR value(in FFE) **
		No	Date	Direct exports	Third Party exports	Deemed Exports	Royalty payments	Forex for R &D Services	Total

* not to be filled in by hotel industry

** Exports/Supplies made/services rendered other than those mentioned in serial number 2 above have to be included for counting average e


DECLARATION/UNDERTAKING
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 there from and if found incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.

2. I/ We hereby declare that I/we have perused the list of SCOMET items as contained in the Appendix 3 to the Schedule 2 of the ITC (HS) Classifications of Export-Import Items, 2004-09 and that the item(s) exported / proposed to be exported does not fall within this list and that I/ We agree to abide by the provisions of the Policy for export of SCOMET items contained in the Foreign Trade Policy, Schedule 2 of ITC (HS) and the Handbook of Procedures (Vol.1), irrespective of the scheme under which the item is exported / proposed to be exported (the underlined portion will be deleted in case an application for export license for SCOMET item is being filed).

3. 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 Telephone Residential Address Email Address

Place Date

GUIDELINES FOR APPLICANTS
1. Two copies of the application must be submitted unless otherwise mentioned.

2. Each individual page of the application has to be signed by the applicant.

3. Application must be accompanied by documents as per details given below:

4. Statement of Export/

1. a. For Physical Exports:

1. Consolidated statement of exports made or individual statements (bank/authorized dealer wise) duly certified by a Chartered Accountant as per format given in Appendix 26 and bank evidencing exports and realisation in freely convertible. However, in case of exports made under an irrevocable letter of credit or a bill of exchange is unconditionally Avalised/ Co- Accepted/Guaranteed by a bank and the same is confirmed by the exporters bank, realization of export proceeds would not be insisted upon provided the final receipts are in free foreign exchange and a confirmation is given by the Bank in this regard.

b. For Deemed Exports:

1. Copy of ARO/Back to Back Inland letter of Credit or Advance Authorisation for Intermediate Supplies or Supply invoices or CT 3 / ARE 3 duly certified by the Bond Office of EOU concerned showing that supplies have been received.

2. Evidence of having received the payment through normal banking channel in the form given in Appendix 22B or a self certified copy of payment certificate issued by the Project Authority concerned in the form given in Appendix-22C.

c. For Services rendered:

1. Consolidated statement or individual statements (bank/authorised dealer wise) of services rendered as given in sub section XV duly certified by a Chartered Accountant as per format given in Appendix 26A and bank/authorised dealer evidencing foreign exchange earning received through normal banking channel.

2. Copy of Authorisation showing the date of clearance of the first consignment

3. Customs purpose copy of EPCG Authorisation

4. At the time of redemption, the Authorisation holder shall also submit certificate from the Independent Chartered Engineer confirming the use of spares so imported under the Scheme in the installed capital goods on the basis of stock & consumption register maintained by Authorisation holder.

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