ANF 3C

For Vishesh Krishi And Gram Udyog Yojana (VKGUY) applications

(for exports during 2004-05/2005-06/2006-07/2007-08/2008-09)

(Please note that application for VKGUY benefits for exports made during 2004-05/2005-06/2006-07 and 2007-08 and 2008-09 cannot be clubbed into one application. Separate applications are required to be filed for separate years.)

(Please note that export shipments from all EDI ports can be filed in one application while for export shipments from each Non-EDI ports, separate application is required to be filed.)

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. Details of export made during the year 2004-05/2005-06/2006-07/2007-08/2008-09. (strike out the years not relevant)

S No	SB no	SB date	Date of Exports in terms of Para 9.12 of HBP v1 [OLD Date of Let Export]	BRC No	BRC date	Invoice No	S No of Invoice	Product Group	ITC(HS) code	Item Description
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)	(11)

FOB value of Exports in free foreign exchange (inclusive of commissions [DELETED-and discounts, if any]) [OLD- FOB Value in free foreign exchange(Inclusive of commission) in Indian Rupees as per BRC/FIRC ]	Customs Rate of Exchange on the date of LEO [Deleted- Exchange Rate on date of let export]	FOB value of Exports in Indian Rupees (inclusive of commissions [DELETED-and discounts, if any]) [Deleted- FOB Value (in Rs)]	VKGUY Entitlement rate (5%)(3.5% for exports covered under Chapter 4 of FTP (including drawback) for import of relevant agricultural inputs)	Entitlement (without cut)	Cut applicable (if any)	VKGUY Entitlement
			(in %)	(in Rs)	(in %)	(in Rs)
(12)	(13)]	(14)=(12) * (13)]	(15)	(16) = (12) X ((15) / 100 [OLD- (16) = (14) * (15) / 100 ]	(17)	(18) = (16) *{1-[(17)/100]}

(In above table the words "and discounts, if any" has been deleted vide PN. NO. 194/2008, DT. 11/08/2009)

(In above table heading for column 12, 13 & 14 has been replaced by PN. NO. 151/2008, DT. 26/02/2009)

(In S. NO. 4, Heading at column 4 - corrected , addition in heading at column 12, column 13 & 14 - deleted, formula at column 16 - modified vide PN. NO. 110/2008, DT. 21/11/2008)

5. Port of Registration (for purpose of Imports):

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

7. Application Submission Details (in case of electronically submitted applications)	8. Application Fee Details
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	(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. I further declare that under Foreign Trade (Development and Regulation) Act (FTDR 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 FTDR 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 in fulfilling 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 the export product is covered under Appendix 37A and the export, for which this application is being filed, are made on or after the respective admissible date of export, as indicated in Appendix 37A.

6. I hereby declare that export product for which VKGUY benefit is being claimed at 5% does not contain any shipment for which benefit under chapter 4 (including drawback) of FTP 2004-09 in respect of exports from 01.04.2006 has been claimed for such relevant agricultural inputs.

7. I hereby declare that no benefit under VKGUY Scheme was availed previously against Shipping Bills currently included in this application.

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

9. I hereby declare that export product for which VKGUY benefit is being claimed does not contain any shipment made w.e.f 1.4.2007/1.4.2008 (as the case may be) from such EOU / BTP Units, on which direct tax exemption is / will be availed and further that these exports are not covered under Sr. No. 10 below.

10. I hereby declare that export product for which benefit is being claimed does not include

i) Export of imported goods covered under Para 2.35 of FTP;

ii) Exports originating in third country and transshipped through India;

iii) Deemed exports;

iv) Exports made by SEZs units; and

v) Items, which are restricted or prohibited for export under Schedule 2 of Export Policy in ITC (HS).

11. I hereby declare that export / supplies do not include any disclaimed third party exports. Thus 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.

12. I undertake to abide by provisions of FTDR Act, 1992, Rules and Orders framed there under, and the FTP.

Place: ____________ Date: _____________ Documents to be submitted 1. Export promotion (EP) copy of Shipping Bill / Bill of Export (including in case of exports through Land Customs or supply to SEZ) 2. Relevant Original Bank Certificate of Exports and Realisation - Appendix 22A / Foreign Inward Remittance Certificates (FIRC) or offsetting of export proceeds with approval of RBI (Appendix 22D). In case of FIRC, a declaration from exporter that remittance is in respect of Shipping Bill(s) No ____________ dtd _________ shall also be furnished. Note: 1. Each individual page of application has to be signed. One Copy of ANF3C duly signed in provided space. Copy of Updated Profile in ANF1 only if any changes have taken place and updated, along with Copy of Valid RCMC. RCMC for MFP and their value added variants should be from SHEFEXIL.

Signature: __________________________ Name: _____________________________ Designation: ________________________ Official Address: ___________________ _____________________________________ Residential Address: ________________ _____________________________________ Telephone: _________________________ Email Address: __________________

2. In cases the original EP copy of Shipping Bill / Bill of Export; and / or BRC/FIRC have been submitted to DGFT/Customs, a copy of the same be attached, quoting reference file number/claim number (if any) and concerned RA / Customs authority where the said original has been submitted. Wherever a copy of the original is submitted, it should be ensured that the same is self-attested by the exporter. [OLD- 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.]

(Above Note 2 has been corrected vide PN. NO. 110/2008, DT. 21/11/2008)

(In the ‘Documents to be submitted’, for Drawback Scheme shipments, a copy of Drawback Shipping Bill may be submitted vide PN. NO. 110/2008, DT. 21/11/2008)

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