APPENDIX 39

APPLICATION FOR FREE SALE & COMMERCE CERTIFICATE

1.	Name of the firm / Company	:
2.	Address of Registered Office	:
	(i) Tel No	:
	(ii) Fax No	:
	(iii) e.mail ID
3.	Importer Exporter Code No	:
	(i) Code No.
	(ii) Name & Address of issuing authority
4.	Registration –cum-Membership Certificate ( RCMC ) details
	(i) Name of the Council
	(ii) Registration No and date
	(iii) Validity
5.	Brief Description of exports	:
	(i) Details of foreign buyer with complete address, e.mail ID etc.
	(ii) Brief description of items to be exported under the certificate
6.	Whether the items of export fall under the Drugs & Cosmetics Act. 1940 . If so, indicate the same.	:
7.	Details of items for which Free Sale & Commerce Certificate is sought to be obtained (Annexure A to be attached duly self-certified)

(Signature)
Name & Designation of the Authorised Signatory
Seal of the Company

Note :

1. This form with Annexure ‘A’ may be submitted without other parts of the Aayat Niryat Form.

2. For items falling under the Drug & Cosmetics Act,1940, application for issue of Free Sale & Commerce Certificate may be made to the Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi-110011.

ANNEXURE A

Sl No.

Name of the equipment / item

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