ANF for Para 3.8.6
For Vishesh Krishi And Gram Udyog Yojana (VKGUY) - Para 3.8.6 application
Exports of products covered under ITC HS Chapter 1 to 24
April-September 2007 / October-March 2008 period

1. IEC Number
2. Applicant Details
i. Name
ii. Address
3. RCMC Details
i. RCMC Number	ii. Date of Issue
iii. Issuing Authority	iv. Valid upto
v. Products for which registered
4. Status Details
i. Status Number	ii. Effective Date of Status Certificate and Validity:
iii. Issuing Authority	iv. Date of issue:

5. Details of exports: - April to September ______/ October to March ______Period

Sr. No	Particulars	FOB value (as per BRC) Rs
1	Total value of exports of products covered under ITC HS Chapter 1 to 24, Details as per Annexure 1 of CA certificate.
2	Maximum Para 3.8.6 benefits (@ 10% of 1 above)
3	Out of 1 above, Total value of exports of products covered / to be under VKGUY Para 3.8.2-Details as per Annexure 2 of CA certificate.
4	Value of Para 3.8.2 benefits (@ 5%/3.5% as the case may be)
5	Claim for duty credit scrip under Para 3.8.6** (Row 2-Row 4)
6	Duty credit scrip granted under Para 3.8.6 (to be filled in by CLA New Delhi)

6. Number of Split Certificates required (in multiples of Rs 5 lakhs each):

7. Port of Registration (for the purpose of imports)***:

(* Exports made on or after 1st April 2007 in terms of Para 9.12)

(*** The port of registration shall be one of the ports from which the exports have been made.)

8. Application Submission Details (in case of electronically submitted applications)	9. Application Fee Details **(as per claim value in 5.5 above)
i. ECOM Reference Number	(i) Amount (Rs):
ii. Date of Submission on Server	(ii) Demand Draft / Bank Receipt / Electronic Fund Transfer No
iii. Submitted to which Regional Authority, New Delhi	(iii) Date of Issue
iv. File Number	(iv) Name of the Bank on which drawn
v. Date of Issue	(v) Bank Branch on which drawn

DECLARATION / UNDERTAKING

1. I hereby declare that particulars and statements made in this application are true and correct and nothing has been concealed or held therefrom. I fully understand that any information furnished in application if found incorrect or false will render my firm / company and me liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.

2. I hereby certify that none of Proprietor/ Partner(s) / Director(s) / Karta / Trustee of firm / company, as the case may be, is a Proprietor / Partner(s) / Director(s) / Karta / Trustee in any other firm / company which has come to adverse notice of DGFT. Consequentially, I further declare that under Foreign Trade (Development and Regulation) Act (FT (D&R) Act) 1992, my firm / company have not been debarred in person from undertaking any export import business or activity by way of suspension or cancellation of IEC number. [If so debarred under FT (D&R) Act, details of said order and period for which the same is operational may be provided].

3. I hereby certify that my firm / company has not defaulted from export obligation under any provisions of FTP and has not been placed under the Denied Entity List (DEL). [If under DEL List, kindly furnish details of order, current status etc.]

4. I hereby declare that details of exports of goods of my firm / company are true and correct and in accordance with accounts maintained in my firm / company.

5. I hereby declare that in terms of Para 3.12.6 of FTP, this application does not contain any exports for which benefit under FPS / FMS under Chapter 3 of FTP has been / will be claimed.

6. I hereby declare that in terms of Para 3.12.8 of FTP, this application does not contain any exports in contravention to this provision.

7. I hereby declare that export product for which Para 3.8.6 benefit is being claimed does not contain any shipment made from such EOU / EHTP / BTP Units, on which direct tax exemption is / will be availed.

8. I hereby declare that export product for which Para 3.8.6 benefit is being claimed does not contain any shipment made from SEZ Units.

9. I hereby declare that the details of exports for which VKGUY benefits under Para 3.8.2 has been claimed / will be claimed has been correctly given in Annexure 2 of CA certificate.

10. I hereby certify that I am authorized to verify and sign this declaration as per Paragraph 9.9 of FTP.

Place: ____________	Signature: __________________________
cDate: _____________	Name: _____________________________
Documents to be submitted	Designation: ________________________
1. CA certificate as per Annexure 2. Export promotion (EP) copy of Shipping Bill / Bill of Export (including in case of exports through Land Customs).	Official Address: _____________________ ___________________________________
3. Relevant Original Bank Certificate of Exports and Realisation - Appendix 22A or offsetting of export proceeds with approval of RBI (Appendix 22D)	Residential Address: __________________ ___________________________________
4. Copy of Status Certificate valid w.e.f 1.4.2007.	Telephone: _________________________
Note: 1. Each individual page of application has to be signed. One Printout of Online application duly signed in provided space. Copy of Updated Profile in ANF 1only if any changes have taken place and updated, along with Copy of Valid RCMC.	Email Address: ______________________
2. In cases where original EP copy of Shipping Bill(s) / Bill of export and/or Bank Realisation Certificates has been submitted under any other scheme of FTP, a self attested photocopy(s) of EP copy of the same be attached, quoting Reference File no. & concerned Regional Authority where original documents have been submitted.

Annexure to ANF for Para 3.8.6

CERTIFICATE OF CHARTERED ACCOUNTANT (CA)
COST AND WORKS ACCOUNTANT (ICWA)/ COMPANY SECRETARY (CS)

I / We hereby confirm that I / We have examined prescribed registers and also relevant records of M/s ....... .............……………………………………………having IEC Number ……………………... for exports during April - September 2007 / October-March 2008 period (s) and hereby certify that:

1	Following documents / records have been furnished by applicant firm / company and have been examined and verified by me / us namely: - a. Statutory documentations under Customs Act 1962, Foreign Trade (Development & Regulation) Act 1992; b. Shipping Bills, Bill of Lading (and / or Airways Bills / PP Receipts), Customs / Bank attested Invoices, Forward Inward Remittance Certificates (FIRCs) and Bank Certificates of exports and realization, and connected books of accounts;
2	Information given by applicant firm / company in ANF for Para 3.8.6 is in agreement with FTP (RE2007) 2004-09, as amended, and rules and procedures made thereunder, relevant register and records and books of accounts maintained by M/s ......... .. ... and is also true and correct.
3	It has been ensured that a. Information furnished is true and correct in all respects; no part of it is false or misleading and no relevant information has been concealed or withheld; b. In respect of export of goods, a shipment can counted in applicants export turnover / performance only if the realization of export proceeds from overseas is in the applicant’s bank account.
4	Neither I, nor any of my / our partners is a partner, director, or an employee of above-named entity, its Group companies or its associated concerns;
5	I / We further certify that export proceeds for shipments during last three years plus current are not outstanding beyond prescribed period as permitted by RBI.
6	I / We further certify that Statement of Exports as given in Annexure 1 to this certificate, and Statement of Exports where VKGUY Para 3.8.2 benefits is already claimed / to be claimed, as per Annexure 2 to this certificate is correct.
7	I / We fully understand that any statement made in this certificate, if proved incorrect or false, will render me / us liable to face any penal action or other consequences as may be prescribed in law or otherwise warranted.

Place: ______________	Signature of CA/ ICWA / CS:_______________________
Date: _______________	Name of the Signatory: ______________________
	Address: _________________________________ _________________________________________
	Membership No: ___________________________
	Email Address: _________________________________
If any of documents of record mentioned in serial number (i) have not been maintained / furnished, examined or verified, they may please be specified below:- 1) 2)

Annexure 1 to CA certificate for ANF for Para 3.8.6
Statement of Exports of products covered under ITC HS Chapter 1 to 24
Sr. No.	Shipping Bill No and Date	Description and ITC HS Code	Date of Export (Para 9.12)	FOB value realized
Total (Rs)
Note: This statement of exports as per annexure 1 should also be countersigned by the applicant.

Place: ______________	Signature of Applicant:_______________________
Date: _______________	Name of the Signatory: ______________________
	Address: _________________________________ _________________________________________
	Email Address: _________________________________

Place: ______________	Signature of CA/ ICWA / CS:_______________________
Date: _______________	Name of the Signatory: ______________________
	Address: _________________________________ _________________________________________
	Membership No: ___________________________
	Email Address: _________________________________

Annexure 2 to CA certificate for ANF for Para 3.8.6
Statement of Exports of products covered under ITC HS Chapter 1 to 24 (as in Annexure 1 above), for which VKGUY benefits under Para 3.8.2 is claimed / will be claimed.
Sr. No.	Shipping Bill No and Date	Date of Export (Para 9.12)	Related file no (Where VKGUY under Para 3.8.2 is already filed)	FOB value realized
Total (Rs)
Note: This statement of exports as per annexure 2 should also be countersigned by the applicant.

Place: ______________	Signature of Applicant:_______________________
Date: _______________	Name of the Signatory: ______________________
	Address: _________________________________ _________________________________________
	Email Address: _________________________________

Place: ______________	Signature of CA/ ICWA / CS:_______________________
Date: _______________	Name of the Signatory: ______________________
	Address: _________________________________ _________________________________________
	Membership No: ___________________________
	Email Address: _________________________________

(Above ANF for Para 3.8.6 has been added vide PN NO. 93/2007, DT. 27/12/2007)