ANF 3G
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 2008 / October-March 2009 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 2008 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 ii. Date of Submission on Server iii. Submitted to which Regional Authority, New Delhi iv. File Number v. Date of Issue	(i) Amount (Rs): (ii) Demand Draft / Bank Receipt / Electronic Fund Transfer No (iii) Date of Issue (iv) Name of the Bank on which drawn (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 (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: __________________________
Date: _____________	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 1.4.2008.	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.

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