APPENDIX 11A

DATA SHEET FOR ADVANCE AUTHORISATION ON SELF DECLARATION BASIS UNDER PARA 4.4.2 & 4.7 OF HBP

1. Details of Items required for manufacture of one Unit of Export Product:

(a) Imported inputs:

S.No.	Required import item			Quantity required per unit of resultant product	Purpose of requirement *	Wastage claimed (%age) on net content basis.	Recoverable wastage/by product
	Description	Technical Character-istics	ITC(HS) Code				Name	Quantity	value

* Purpose of requirement should be indicated against each item whether the same is required as raw material, components, consumables solvents, catalysts, packing material etc.

(b) Indigenous inputs

S.No.	Required import item			Quantity required per unit of resultant product	Purpose of requirement *	Wastage claimed (%age) on net content basis.	Recoverable wastage/by product
	Description	Technical Character-istics	ITC(HS) Code				Name	Quantity	value

2. Production and consumption data of the manufacturer/supporting manufacturer (of preceding three licensing years duly certified by the Chartered Accountant/Cost and Works Accountant/Jurisdictional Central Excise Authority*):

*In case there is no past production, the Jurisdictional Central Excise Authority shall certify the production and consumption data on the basis of production batch sheets and for this purpose the firm shall maintain separate record of batch data for inputs consumed in the manufacture of the export product.

Year	Total production of the resultant product	Quantity of different Items consumed	Quantity consumed/unit production
(1)	(2)	(3)	(4)

3. Particulars of the authorisations (erstwhile licences) obtained in the past and ratified by Norms Committee (NC) (with or without modification) for the same export product covered under this application.

S.No.	Authorisation No & Date	Description of export product	Description of import items	Import item qty per unit of export product (as applied for)	Import item qty per unit of export product (as approved by NC while ratifying licence)	NC meeting No & Date when approved
(1)	(2)	(3)	(4)	(5)	(6)	(7)

4. Please furnish technical details as per Appendix 33 depending upon the resultant product. Please confirm.

5. a) FOB value of exports in the preceding licensing years b) CIF value of authorisations already obtained under paragraph 4.7 c) Balance entitlement as per paragraph 4.7.1.

: : :

CHARTERED ENGINEER CERTIFICATE

I have examined the applicant company"s import requirements of raw materials, components etc with regard to their technical description/ specification and the quantity against each item of import and having regard to proper technical norms of consumption and after technical scrutiny of relevant designs and drawings, I hereby certify that they are correct in all respects and are actually required for the execution of the export/supply contracts for .........................

The list of Items covers _________ pages and contains __________ items for a total value of Rs._____________ (in free foreign exchange __________ )

Place: ............. Date: ..............

Signature.................................. Name in Block letters................ Designation............................... Address.................................... Name and Address of the Institution under which Chartered: .................................. Ref No. and date of Corporate Membership : ..................................