PREVIOUS

AAYAAT- NIRYAAT FORM (Part - II)

SUB SECTION V C
(For DEPB Scheme)

1. FOB Value of exports (inclusive of commission)

i. In Rupees
ii. In freely convertible currency

2. DEPB Claimed

i. In Rupees (in words)
ii. In Rupees (in figures)

3. Port of Registration (for the purpose of imports):

4. Whether application made for transferable duty credit:          Yes/No

5. Details of export made

S No	SB no	SB date	Date of Let Export	BRC No	BRC date	Invoice No	S No of Invoice	Pro-duct Group	DEPB Sr No	Item Des-crip-tion	FOB Value in free foreign exch-ange (inclu-sive of commi-ssion)	Exch-ange Rate on date of let export	FOB Value ( in Rs)
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)	(11)	(12)	(13)	(14)=(12) * (13)

Computation of Capped Value					DEPB rate	DEPB entitlement (without cut)	Cut applicable (if any)	Actual DEPB Entitlement
Unit of Measurement in the unit of value cap	Export Qty in U/M	Value Cap	FOB per U/M	Capped Value	(in %)	(in Rs)	(in %)	(in Rs)
(15)	(16)	(17)	(18)= (14) / (16)	(19)={ minimum of (17) and (18)} or (18) as the case may be	(20)	(21) = (16) * (19) * (20) / 100	(22)	(23) = (21) *{ 1-[(22)/100]}

Note: In case there is no value cap on the product, the capped value would be equal to the FOB value per unit of measurement (U/M) as at Column (18) of the table above. Else it would be the minimum of Columns (17) and (18)

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SUB SECTION VI

(For EPCG Licence)

1. Sector Classification of Capital Goods sought to be imported under the Scheme (Please tick)

i. Industrial sector
ii. Agricultural sector
iii. Port sector
iv. Service sector
v. Retail sector
vi. Others

2. Products to be exported/Services to be rendered:

3. Whether any export obligation has been imposed in the Letter of Intent/Industrial Licence/Foreign Collaboration approval          Yes/No

If yes, please furnish details thereof including EO fulfilled, if any

4. In case of Service Provider, please furnish

i. Serial No of Appendix 36 under which classified
ii. Whether registered with Service tax authorities          Yes/No

5. Whether imports made are also Project Imports as per Para 5.1B of Policy          Yes/No

5A. Whether imports made are under Technological Upgradation Scheme          Yes/No

i. Details of previous EPCG Licence i.e EPCG Licence Number, Date

ii. Details of CIF/duty saved under the Licence, EO fulfilled in FOB and %age terms

6. Details of exports/deemed supplies made in the preceding 3 licensing years for the same or similar product

Licensing Year	Products exported/Supplied/Services rendered	FOB Value of exports/services rendered (in Rs Crore)	FOR Value of Deemed supplies(in Rs Crore)	Total Export performance (in Rs Crore)

7. Details of EPCG Licences already obtained and which have not been redeemed

S No	Licence No	Licence Date	CIF Value (Rs)	EO fixedin freely convertible currency	%age of EO fulfilled	Expiry Date of EO period

8. Details of Capital Goods applied for import

S No	Description of the items of import	Nature of Capital Goods sought to be imported +	Primary Use of Capital Goods sought to be imported ++

Technical Specifications/Model No. etc	Quantity	CIF Value in freely convertible currency

+ - whether Capital Goods/ Spares/ Tools/Jigs/Fixtures/Dies/Moulds/ Refractories/Catalyst/ Consumables

++ - whether used for Pre Production activity/ Production activity/ Post Production activity/ For rendering Services

9. Details of Duty Saved

Total effective Customs duty on items to be imported/deemed to be imported (in %) +++	Duty to be levied under the Scheme(in %)	Duty Saved (in %)	CIF Value of imports/deemed imports (in Rs)	Duty saved(in Rs)
1	2	3 = 1 - 2	4	5 = 3 * 4 / 100

Note:

1. +++ In case of indigenous sourcing of CG, duty saved is to be calculated on notional Customs duties saved on FOR value of capital goods as per para 5.7 A of FTP.

2. In case of EPCG Licence for Projects as per para 5.1B of Policy, the basic customs duty would be 10%. Wherever, CVD is paid in cash and not subsequently Cenvated, CVD would not be taken for computation of net duty saved.

10 A. Export Obligation ( as a multiple of duty saved) to be imposed (please tick)	√
i. Eight times duty saved
ii. Six times duty saved (in case of imports made by SSI, agro units and technological upgradation scheme)

10 B. Export Obligation period to be imposed (please tick)	√
i. Eight years from date of issue of Licence
ii. Twelve years from date of issue of Licence

10 C. Export Obligation to be imposed

i. In Rupees
ii. In freely convertible currency

10 D. Average Export Obligation to be imposed

i. In Rupees
ii. In freely convertible currency

11. Port of Registration (for the purpose of imports):

12 A. Address of the factory/premises where the capital goods to be imported are proposed to be installed

12 B. In case the proposed CG sought to be imported are to be used by the supporting manufacturer, please furnish

i. Name of the supporting manufacturer
ii. Address of the supporting manufacturer
iii. SSI/LOI/IL regn no. and date
iv. Products endorsed on SSI/IL/IEM

12 C. Address of the jurisdictional Central Excise Authority under whom the proposed CG is to be installed

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SUB SECTION VII

(For Served from India scheme)

1.
i. Serial No of Appendix 36 under which classified
ii. Whether registered with Service tax authorities          Yes/No

2. Category of Service Provider (please tick)	( √ )
i. Hotels
ii. Stand alone Restaurants
iii. Healthcare
iv. Education
v. Individual
vi. Others

3. Details of free foreign exchange earned

Services rendered in free foreign exchange (in equivalent Indian Rs)		Duty Free Credit Entitlement (in Rs)
2005-06 +	2004-05
(1)	(2)	(3) = 0.1 * (2) However in case of Hotels (3) =0.05* (2) and in case of Restaurants (3)= 0.2* (2)

+ - to be filled in cases where the applicant claims eligibility under the scheme on the current year basis

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

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

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SUB SECTION VIII

(For Vishesh Krishi Upaj Yojana)

1. FOB Value of exports

i. In Rupees
ii. In freely convertible currency

2. Duty Free Credit Entitlement

i. In Rupees (in words)
ii. In Rupees (in figures)

3. Port of Registration (for the purpose of imports):

4. Whether application made for transferable duty credit:          Yes/No

5. Details of export made

S No	SB no	SB date	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 in free foreign exchange(inclusive of commission)	Exchange Rate on date of let export	FOB Value ( in Rs)	VKUY Entitlement rate	VKUY entitlement (without cut)	Cut applicable (if any)	Actual VKUY Entitlement
			(in %)	(in Rs)	(in %)	(in Rs)
(12)	(13)	(14)=(12) * (13)	(15)	(16) = (14) * (15) / 100	(17)	(18) = (16) *{ 1-[(17)/100]}

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

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SUB SECTION IX

(For Target Plus Scheme)
for 2005-2006
TO BE NOTIFIED SEPERATELY

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SUB SECTION X

Part-A     For Claiming Duty Drawback on All Industry Rates/Fixation of Drawback Rates/Refund of terminal Excise Duty

1. Details of products supplied

i. Description
ii. Technical Characteristics
iii. Net Weight of the product supplied per unit
iv. Serial No of All Industry Rate in Drawback Schedule
v. All Industry Drawback Rate in Drawback Schedule
vi. Central Excise Tariff Chapter / Heading under which classified
vii. Rate of Central excise Duty payable on product supplied
viii. Current FOR prices of product supplied
ix. Total Production value of the product supplied in the preceding three years

2. Mode of Supplies (please tick)	( √ )
i. Under Central Excise Bond
ii. After payment of duty under claim of rebate of Central Excise Duty
iii. Otherwise

3. i. Whether in respect of any of raw material/components the benefits under Rule 18 & 19 of Central Excise Rules, 2002 or any other Central Excise Rules is being availed of? ii. If so the details thereof in respect of each input/raw material:	Yes/No
4. i. Whether in respect of any of raw material/components CENVAT benefits under Rule 3 of CENVAT credit Rule, 2004 of Central Excise Rules is being availed of ? ii. If so the details thereof in respect of each input/raw material:	Yes/No
5. i. Whether any declaration has been filed in terms of Rule 57(g) (1) of Central Excise Rules for availing CENVAT benefits under Rule 3? ii. If so, details of inputs for which such benefit claimed	Yes/No
6. i. Whether any other benefit under any of the Customs and/or Central Excise Notification is being availed of in respect of the raw material, components and other inputs used in the product supplied? ii. if so, the details thereof	Yes/No
7. i. Whether in respect of the imported material benefits of Duty Exemption Scheme are being availed of? ii. If so, the Licence details may be furnished: iii. File Number of Advance Licence wherein Drawback claim declaration has been filed:	Yes/No
8. i. Whether in respect of the imported material, manufacture under Bond procedure in terms of Section 65 of Customs Act, 1962 is being followed? ii. If so, the details thereof	Yes/No

Part B For Fixation of Duty Drawback rates

9. Please tick whichever is applicable	( √ )
i. Under Rule 6 (1) (a) of Drawback
ii. Under Rule 7 (1) of Drawback

10. Drawback rate or amounts expected (enclose working sheet in support thereof):

11. In case the application is for fixing of Brand Rate under Rule 7(1) of Drawback Rules, is the rate indicated in Serial No 1 (v) less than four-fifth of the rate indicated in serial 10 above.

12. In case the application is for fixing of Brand Rate under Rule 6 of Drawback Rules, is the rate worked out as at serial 10 above more than 1% of FOR value, if so the percentage of Drawback rate expected to FOR value.

13. Is the FOR value with regard to each item in the Supply Invoice less than the value of all imported materials used in the manufacturing of such goods?

14. If not, what is the percentage of value addition against each entry in the Supply Invoice.

15. Brief Process of Manufacture (enclose catalogue/literature etc. of the items of import)

Part C For Refund of Terminal Excise Duty

16.
i. Central Excise Tariff Chapter/Heading in which classified
ii. Rate of Central Excise Duty payable on the product supplied

17. Central Excise Invoice and corresponding ER-1/ER-3 showing amount of Terminal Excise Duty paid or self certified Invoice showing the amount of Terminal Excise Duty paid

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PART 3

1. IEC Number

2. Applicant Details

i. Name
ii. Address

3. Application for (please tick whichever is applicable) :	( √ )
XI. Enhancement in CIF/FOB Value or Revalidation or EO extension of Licence
XII. Fixation/Modification of Standard Input Output Norms (SION)
XIII. Fixation of DEPB Rates/ Fuel Rates
XIV. Redemption of Advance Licence
XV. Statement of Export/Redemption of EPCG Licence
XVI. EO Refixation under EPCG Scheme
XVII. Clubbing of Licences
XVIII. Statement of Imports made under Served from India Scheme/Target Plus Scheme
XIX. Refund of Application Fee

4. Application Fee Details

Amount (Rs)
Demand Draft/Bank Receipt/Electronic Fund Transfer No
Date of Issue
Name of the Bank on which drawn
Bank Branch on which drawn

Note:

1. Only one category of application may be made in the Form.

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SUB SECTION XI

(For CIF/FOB enhancement or Revalidation or EO extension of Licence)

1. Licence details

i. Licence Number
ii. Licence Date
iii. File Number from which Licence is issued
iv. Original CIF Value (Rs)
v. Original FOB Value (Rs)
vi. Original Value Addition (%)
vii. Initial Validity
viii. Extended Validity, if any
ix. Initial EO Period

x. Extended EO period, if any

2. Details of import items and utilisation of Licence

S No	Item Description	Original CIF Value (Rs)	Quantity endorsed in the Licence (in metric units)	Balance Quantity available in the Licence		Balance CIF ValueAvailable in the Licence		Proposed CIF value (Rs) (in case of request for CIF enhancement)
				In metric units	In %	In Rs	In %

3. Details of Export Obligation fulfillment

S No	Item Description	FOB Value (Rs)	Quantity to be exported (in metric units)	EO completed		Unfulfilled EO
				In Value terms (Rs / %)	In Quantity terms (%)	In Value terms (Rs / %)	In Qty terms (%)

4. Changes Required in the Licence

a. In case of request for CIF/FOB enhancement
i. Proposed CIF Value (Rs)
ii. Proposed FOB Value (Rs)
iii. Proposed Value Addition (%)
b. In case of request for revalidation
i. Revalidation applied upto
c. In case of request for EO extension
i. Extension in EO period applied upto

5. Reasons for seeking CIF/FOB enhancement/Revalidation/EO extension:

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SUB SECTION XII

(For Fixation/Modification of Standard Input Output Norms -SION)

1. Export Product Details

i. Description of Export Product
ii. Export Product Group

2. 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 export product	Purpose of requirement*	Wastage Claimed (%age) on net content basis	Recoverable wastage / by product
	Name	Technical Characteristics	ITC(HS) Code				Name	Qty	Value (Rs)

B. Indigenous Inputs

S No	Required indigenous item			Quantity required per unit of export product	Purpose of requirement*	Wastage Claimed (%age) on net content basis	Recoverable wastage / by product
	Name	Technical Characteristics	ITC(HS) Code				Name	Qty	Value (Rs)

(* - Purpose of requirement should be indicated against each item i.e. whether the item is required as a raw material/components/solvents/catalyst/packing material etc)

3. Production and Consumption data of the manufacturer/supporting manufacturer for preceding three licensing years

Year	Total Production of theexport product	Quantity of different items consumed	Quantity consumed/unit production

4. Details of earlier advance licences obtained (if any) for the export product in the preceding two licensing years

S No	Licence Details			Quantity of different items consumed	Quantity consumed/unit production
	Licence No	Licence Date	Issuing authority

5. In case the application is made for modification in existing SION, please furnish

i. Existing SION Number
ii. Nature of Modification required
iii. Details of Modification required (attach details)

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SUB SECTION XIII

(For Fixation of DEPB Rates/ Fuel Rates)

1. Application for (please tick)	( √ )
i. Fixation of DEPB rate
ii. Fixation of Fuel rate

2. Export Product Details for which fixation of rate is sought

i. Description of Export Product
ii. Export Product Group
iii. SION serial number in Handbook of Procedures Vol 2

3. Details of imports made during the last one year of inputs allowed under Standard Input Output Norms (SION)

S No	Item of Import	Bill of Entry No	Bill of Entry date	Quantity imported	CIF Value (Rs)	CIF Value per unit (Rs)

4. Details of exports made during the last one year of export product for which fixation of rate is sought

S No	Item of Export	Shipping Bill No	Shipping Bill date	Quantity exported(by weight)	FOB Value (Rs)	FOB Value per kg (Rs)

5. Details of international journals/magazines evidencing international price of inputs in support of data furnished above

6. In case of fixation of fuel rate is sought, please furnish

i. Type of Fuel stipulated in permission issued by Competent Authority
for installation of Captive Power Plant

ii. Units (KWH) of Electricity consumed
for producing One kg of export product

iii. Cost of Fuel per kg of export product

7. Worksheet for Computation of DEPB Rates

S No	SION Details					Customs Duty suffered (Rs/ US $)
	Description of inputs allowed	Quantity allowed	CIF Value per unit quantity of imports allowed (Rs/ US $)	CIF value of inputs allowed (Rs/ US $)	Rate of Customs Duty (%)
FOB Value per unit quantity of export product(Rs/ US $):				Total CIF value:		Total Duty:

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SUB SECTION XIV

(For Redemption of Advance Licence)

1. Advance Licence Details

i a. Advance Licence Number
I b. Date of Issue
ii. CIF Value
a. In Indian Rupees
b. In free foreign exchange
iii. Export Obligation imposed
a. In Indian Rupees
b. In free foreign exchange
Iv a Date of expiry of initial export obligation period
iv b. Date of expiry of extended export obligation period
v. Product to be exported
Vi a. Serial Number of SION (in case of fixed norms)
Vi b. Reference number and date vide
which norms have been ratified (in case of para 4.7 cases)

2. Details of physical exports/deemed exports made

S No	Products Exported/ Supplied	Shipping Bill/ Invoice/ AR 3 Details		Quantity Exported / Supplied				FOB Value
		No	Date	Direct exports	Third Party exports	Deemed Exports	Total	In case of physical exports (as per S/B)	In case of deemed exports (as per invoices)	Actually realized (as per BRC)

3. Details of imports made against the Licence

S No	Item of Import	Qty allowed in the Licence	CIF Value allowed in the Licence( in FFE)	Bill of Entry Details		Quantity imported	CIF Value (in FFE)
				No	Date

4. Details of excess imports made proportionate to the export obligation fulfilled

S No	Item of Import	Bill of Entry Details		Quantity	Duty Details
		No	Date		Customs Duty	Interest	Total

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SUB SECTION XV

( For Statement of Export/Redemption of EPCG Licence)

1. EPCG Licence Details

i a. EPCG Licence Number
I b. Date of Issue
ii. CIF Value/Duty saved value endorsed on the Licence
a. In Indian Rupees
b. In free foreign exchange
iii. Export Obligation imposed on the Licence
a. In Indian Rupees
b. In free foreign exchange
iv. Average Exports to be maintained
a. In Indian Rupees
v. CIF Value/ Duty saved value utilized
a. In Indian Rupees
b. In free foreign exchange
vi. Export Obligation wrt imports made under Licence
a. In Indian Rupees
b. In free foreign exchange
vii a Date of expiry of initial export obligation period
vii b. Date of expiry of extended export obligation period
Vii c. Date of completion of export obligation
viii. Product to be exported/Services rendered

2. Details of physical exports/deemed exports made/services rendered

S No	Products Exported/ Supplied/Services rendered	Shipping Bill/ Voucher/Invoice/ AR 3/ Lorry Receipt/ Railway Receipt Details +		FOB / FOR value(in FFE/) ++
		No	Date	Direct exports	Third Party exports	Deemed Exports	Royalty payments	Forex for R &D Services	Total

+ not tobe filled in by hotel industry

++ Only Exports/ Supplies made/ capable of being made/ services rendered out of capital goods imported under the Licence for discharge of export obligation imposed on the Licence and export proceeds realized to be included

3. Details of physical exports/deemed exports made/ services rendered for maintaining average exports under the EPCG Licence

Year	Products Exported/ Supplied	Shipping Bill/ Voucher/Invoice/ AR 3/ Lorry Receipt/ Railway Receipt Details *		FOB / FOR value(in FFE) **
		No	Date	Direct exports	Third Party exports	Deemed Exports	Royalty payments	Forex for R &D Services	Total

* not to be filled in by hotel industry

** Exports/Supplies made/services rendered other than those mentioned in serial number 2 above have to be included for counting average exports

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SUB SECTION XVI

(For EO Refixation under EPCG Scheme)

Note: 1. Please see paragraph 5.4 (i) of the Policy and paragraph 5.19 of the Handbook (Vol.I)

File No

Date

1.	Name and address of the applicant	:	M/S
2.	IEC Number	:
3.	Block year of Export Obligation fulfilment	:	1st year [ ]	2nd year [ ]	3rd year [ ]	4th year [ ]
			5th year [ ]	6th year [ ]	7th year [ ]	8th year [ ]
			9th year [ ]	10th year[ ]	11th year[ ]	12th year[ ]
4.	Exports mandated under the block prescribed in row above	:	As a percentage of total exports to be made
5.	Export actually made	:	As a percentage of the total exports to be made

6. Details of EPCG licence presented for refixation of export obligation :

S. No	EPCG Licence No	Date of Issue	Export Product(s)	Capital Goods applied for import	Export obligation fixed as per imports made (in US $)	Exports actually made(In US $)	% of exports unfulfilled
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8) = 100*((6)- (7))/(6)

CIF Value of imports (in US $)	Total Customs Duty Saved (10)					Refixed Export Obligation
(9)	Basic (A)	Additional/ CVD (B)	Others (SAD, etc if applicable)(C)	Rate of Duty levied on import (D)	Total Duty saved (A+B+C-D)	(11)
						=8* (10)*(8)/100 for cases where refixation application is made within 2 years from the date of issue of EPCG Licence =2*(10)*(8)/100 for cases where the remaining EO is less than 2 years on the date of application for refixation

Signature of the Applicant:
Name:
Designation:
Official Address:
Residential Address :
E-mail address:
Place: Date:

Documents to be enclosed with the application form:

1. Original copy of EPCG licence

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SUB SECTION XVII

(For Clubbing of Licences)

PART A: ADVANCE LICENCES

1. Details of Advance Licences to be clubbed

S No	Advance Licence No	Advance Licence date	Customs Notification no	Export product	Port of Registration
1	2	3	4	5	6

CIF value permitted(in Rs)	CIF value used (in FFE)	EO imposed (FFE)	Exports made(FFE)	Expiry date of initial EO period	Expiry date of extended EO period
7	8	9	10	11	12

2. Details of physical exports/deemed exports made against each individual Advance Licence

S No	Products Exported/ Supplied	Shipping Bill/ Invoice/ AR 3 Details		Quantity Exported / Supplied				FOB Value
		No	Date	Direct exports	Third Party exports	Deemed Exports	Total	In case of physical exports (as per S/B)	In case of deemed exports (as per invoices)	Actually realized (as per BRC)

3. Details of imports allowed and made against each individual Advance Licence

S No	Item of Import	Qty allowed in the Licence	CIF Value allowed in the Licence( in FFE)	Bill of Entry Details		Quantity imported	CIF Value used (in FFE)
				No	Date

4. Consolidated Details of physical exports/deemed exports made against all Advance licences

S No	Products Exported/ Supplied	Shipping Bill/ Invoice/ AR 3 Details		Quantity Exported / Supplied				FOB Value
		No	Date	Direct exports	Third Party exports	Deemed Exports	Total	In case of physical exports (as per S/B)	In case of deemed exports (as per invoices)	Actually realized (as per BRC)

5. Consolidated Details of imports allowed and made against all Advance Licences

S No	Item of Import	Qty allowed in the Licence	CIF Value allowed in the Licence( in FFE)	Bill of Entry Details		Quantity imported	CIF Value (in FFE)
				No	Date

6. Details of excess imports made proportionate to the export obligation fulfilled

S No	Item of Import	Bill of Entry Details		Quantity	Duty Details
		No	Date		Customs Duty	Interest	Total

PART B: EPCG LICENCES

1. Details of EPCG Licences to be clubbed

S No	EPCG Licence No	EPCG Licence date	Customs Notification no	Export product/Services to be rendered	Port of Registration
1	2	3	4	5	6

CIF value /duty saved permitted (Rs)	CIF value/ duty saved utilized (Rs)	Customs duty saved (Rs)	EO endorsed on the Licence	EO wrt imports made(US $)	Exports made/Services rendered( US $)
7	8	9	10	11	12

2. Details of single clubbed EPCG Licence

i. Total Duty Saved or CIF Value on the imports/deemed imports
a. In Indian Rupees
b. In free foreign exchange
ii. Export Obligation imposed on the Licence
a. In Indian Rupees
b. In free foreign exchange
iii. Average Export Obligation imposed (Rs)
iv. Export Product/Service to be rendered

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SUB SECTION XVIII

(For Statement of Imports made under Served from India / Target Plus Scheme)

1. Application for (please tick)	( √ )
i. Served from India Scheme
ii. Target Plus Scheme

2. Licence Details

i. Licence Number
ii. Licence Date
iii. Issuing Authority
iv. Duty Credit Issued (Rs)
v. Duty Credit Utilised (Rs)

3. Details of imports made

S No	Item of Import	Bill of Entry No	Bill of Entry date	Custom House	Qty imported	CIF Value (Rs)	Duty debited (Rs)

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SUB SECTION XIX

(For Refund of Application Fee)

1. Licensing Authority with whom the application has been filed/was proposed to be filed:

2. Category under which refund is being claimed (please tick)	( √ )
i. Deposited in excess of the specified scale
ii. Deposited in error but applicant is exempt from fee payment
iii. Deposited but no application has been made

3. In case refund is claimed for Category 2 (i) above, please furnish
i. File Number
ii. CIF Value of Licence applied for (Rs)
iii. Fee payable at the prescribed scale (Rs)
iv. Excess fee paid for which refund is claimed (Rs)

4. In case refund is claimed for Category 2 (ii) above, please furnish
i. File Number
ii. Amount of fee paid (Rs)
iii. Category of Clause 5(3) of Foreign trade (Regulation) Rules, 1992 under which exemption is being claimed

5. In case refund is claimed for Category 2 (iii) above,
please state the reasons for not making an application after depositing the fee:

6. In case refund is being claimed after one year of deposit of the fee,
please state the reasons for not making the refund application earlier:

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PART 4

DECLARATION/UNDERTAKING

1. I/We hereby declare that the particulars and the statements made in this application are true and correct to the best of my/our knowledge and belief and nothing has been concealed or held there from.

2. I/We fully understand that any information furnished in the application if found incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.

3. I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, the Rules and Orders framed there under, the Foreign Trade Policy, the Handbook of Procedures and the ITC(HS) Classification of Export & Import Items.

4.
a. I/We hereby certify that the firm/company for whom the application has been made has not been penalized under the Customs Act, Excise Act, Foreign Trade (Development & Regulation) Act 1992 and FERA/FEMA.

b. I/We hereby certify that none of the Proprietor/ Partner(s)/ Director(s)/Karta/Trustee of the firm/company, as the case may be, is/are a Proprietor/Partner(s)/Director(s)/Karta/Trustee in any other firm/Company which has come to the adverse notice of DGFT.

c. I/We hereby certify that the Proprietor/Partner(s)/Director(s)/Karta/Trustee, as the case may be, of the firm/company is/are not associated as Proprietor/Partner(s)/Director(s)/Karta/Trustee in any other firm/company which is in the caution list of RBI.

d. I/We hereby certify that neither the Registered Office/Head Office of the firm/company nor any of its Branch Office(s)/Unit(s)/Division(s) has been declared a defaulter and has otherwise been made ineligible for undertaking import/export under any of the provisions of the Policy.

5. I/We hereby declare that I/We have not obtained nor applied for such benefits (including issuance of an Importer Exporter Code Number) in the name of our Registered/Head Office or any of our Branch(s)/Unit(s)/Division(s) to any other Licensing Authority.

Note: Please tick the clause(s) given below which are applicable to you

5A. I/ We hereby declare that I/we have perused the list of SCOMET items as contained in the Appendix 3 to the Schedule 2 of the ITC (HS) Classifications of Export-Import Items, 2004-09 and that the item(s) exported / proposed to be exported does not fall within this list and that I/ We agree to abide by the provisions of the Policy for export of SCOMET items contained in the Foreign Trade Policy, Schedule 2 of ITC (HS) and the Handbook of Procedures (Vol.1), irrespective of the scheme under which the item is exported / proposed to be exported (the underlined portion will be deleted in case an application for export license for SCOMET item is being filed).

(Above para 5A. has been added vide PN NO. 36/2005, DT. 02/08/2005)

6. I/We solemnly declare that I/We have applied for / obtained a RCMC to the Export Promotion Council which pertains to our main line of business. In case we have applied to any other council, the application has been made within the purview of the provisions of Para 3.12 and Para 3.12.1 of the Handbook of Procedures (Vol 1).

7. (applicable in case of IEC applications only)

a.
i) There is no non-resident interest in the firm/company and no non resident investment with or without repatriation benefits has been made in the firm/company; or

ii) There is non-resident interest in the firm/company and non resident investment without repatriation benefits in the firm/company is held with the general/specific permission of RBI; or

iii) There is non-resident interest in the firm/company and non-resident investment with repatriation benefits in the firm/company is held with the specific permission of RBI.

8. (applicable in case of Issue of Import Certificate under Indo-US Memorandum)

I _________________ (Name of the Organization), a Government entity/Government controlled entity/ private sector entity (Delete whichever is not applicable) hereby undertake

i) To import the item into India and not to redirect it or any part of it, to another destination before its arrival in India;

ii) To provide, if asked, verification that possession of item was taken;

iii) Not to re-export the item without any written approval of Certificate Issuing Authority;

iv) Not to retransfer within India the item(s) specified in this certificate without the written approval of the Certificate Issuing Authority;

v) To obtain permission in writing from the Certificate Issuing Authority prior to any change in end-user which shall be preceded by the new end-user notifying the Certificate Issuing Authority that he/she agrees to the conditions contained in this document;

vi) The items being imported will/will not be integrated into Indian end-products to be exported.

9. (applicable in case of SCOMET applications only)

a. I/We further undertake to submit to the o/o DGFT (PC-III Section), Udyog Bhavan, New Delhi a copy of the bill of entry into the destination state party within 30 days of delivery, failing which I/We shall be liable to action under Foreign Trade (Development & Regulation) Act, 1992 or rules and orders made there under, and the Customs Act, 1962.

b. I/We also hereby inform that we have complied with the conditions of all previous licences issued to us for export of SCOMET items and have duly intimated the o/o DGFT, New Delhi along with documentary evidence in the stipulated time regarding receipt of the items of export by only the end-user as per the respective applications.

10. (applicable in case of Grant of Star Export House certificate only)

a. I/We hereby declare that this application is based on the FOB/FOR export performance of the preceding three licensing years and/or the present licensing year as per the Chartered Accountant certificate submitted in this behalf along with this application.

b. I/We hereby declare that the FOB/FOR value of exports shown in Part 2 of the application are my/our direct exports/supplies and also the direct exports/supplies of our subsidiary company and are true and correct and in accordance with the accounts maintained by me/us.

c. I/We hereby declare that exports made on re-export basis have not been included in the export performance on the basis of which Star Export House recognition is being claimed.

d. I/We hereby declare that the benefit of double weightage of exports for grant of Star Export House recognition is as per the provisions of the Policy.

e. I/We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which RBI permission has been obtained.

f. I/We hereby undertake to maintain true and proper accounts of our exports and imports based on which the Star Export House recognition is being claimed and the exports and imports made during the validity period of such recognition certificate, for a minimum period of three years from the expiry of the validity of such certificate.

11. (applicable in case of Advance Licence applications only)

a. I/We hereby declare that in respect of products for which Standard Input Output norms (SION) are not fixed, I/We shall abide by the final fixation of norms by the Advance Licensing Committee (ALC) and shall pay in cash to the Government Customs duty together with 15% interest reckoned from the date of imports till the date of deposit on the inputs imported in excess of the norms fixed by ALC.

b. I/We hereby declare that we shall only import inputs which are required for the manufacture of the export product(s) and no part of it shall be sold/transferred/disposed off or utilised in a manner in contravention to the provisions of the Policy and Handbook.

c. I/We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which RBI permission has been obtained.

12. (applicable in case of GEM REP applications only)

I/We declare that outstanding realisation of export proceeds beyond 180 days does not exceed 10% of average exports of preceding three licensing years. I/We further declare that no export proceeds are outstanding beyond the period of one year or such extended period for which RBI permission has been obtained.

13. (applicable in case of EPCG applications only)

a. In the event of failure to fulfill the export obligation as stipulated within the export obligation period prescribed or subsequently extended by the competent authority, I/We shall be liable to penal action in accordance with the Policy/Procedure/Foreign Trade (Development & Regulation) Act, 1992 the Rules and Orders framed there under and the Customs Act, 1962 in addition to forfeiture of Bank Guarantee or any other Bond/Guarantee executed with the Customs/Licensing Authority.

b. I/We declare that no export proceeds are outstanding beyond the prescribed period as laid down by the RBI, or such extended period for which RBI permission has been obtained.

c. I/We hereby declare that the capital goods/spares sought for import in the application are actually required for use at pre production/production/post production stages for the export product(s) or for rendering services for fulfilment of export obligation.

d. I/We hereby declare that in respect of goods for which nexus is not established at a later date, I/We shall pay to the Government Customs duty saved together with 15% interest on such imported goods which are found having no relation with product exported or service rendered.

e. I/We hereby declare that in case of import of refurbished/reconditioned spares, the refurbished/reconditioned spares have a residual life which is not less than 80% of the life of the original spares.

f. I/We hereby declare that I/We do not come under the purview of Service Tax and therefore are not registered with the Service Tax Cell of the jurisdictional Central Excise Authorities. (in case of Service Providers who are not covered under service tax).

g. I/We hereby declare that I/We shall not exceed the SSI investment limit in plant and machinery after making imports under the EPCG Licence (applicable in cases of imports made by SSI sector)

h. I/We hereby declare that the import of capital goods shall be used for building and operating shopping malls/super markets having a minimum covered area of 1000 sq metres. (applicable in case of imports made by Retail sector).

i. I/We hereby declare that I/We have not made imports under the Technological Upgradation Scheme previously before any Licensing authority and the present imports of Capital Goods to be made under this Scheme (for which this application is made) are more than 10% of the my/our present investment in the plant and machinery. (applicable in case of imports under EPCG Technological Upgradation Scheme)

14. (applicable in case of Served from India Scheme only)

a. I/We hereby certify that only such foreign exchange remittances as are earned on account of the services rendered and received in freely convertible currency have been taken into consideration while arriving at the computation of the duty credit entitlement under the Scheme and other sources of foreign exchange earnings such as equity or debt participation, donations, repayment of loans and any other inflow of foreign exchange unrelated to the service rendered has not been considered while arriving at the computation of the duty credit entitlement under the Scheme.

b. I/We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which RBI permission has been obtained.

c. I/We hereby undertake that in case of non realisation of export proceeds or lesser realisation of export proceeds in free foreign exchange, I/We shall pay in cash, an amount equivalent to the duty free credit entitlement already obtained on the non-realised basis or lesser realised value of export proceeds together with 15% interest reckoned from the date of imports till the date of deposit.

d. I/We (applicable in case of hotels and stand alone restaurants including 1 star and above hotels and heritage hotels) hereby undertake to pass on the benefit of the duty credit entitlement to the consumers and undertake to submit a statement of utilization of duty credit entitlement in the prescribed format to the licensing authority in this behalf.

e. I/We hereby undertake to submit to the Licensing Authority (with a copy to the jurisdictional Excise Authorities), a statement of imports made under the Scheme within one month of the completion of imports or the expiry of the validity of the duty credit entitlement certificate, whichever is earlier.

f. I/We hereby undertake that the imports to be made under this duty free credit entitlement certificate shall be related to my/our main line of business and I/We further undertake that such imported goods shall not be sold/transferred/disposed off or utilised in a manner in contravention to the provisions of the Policy and Handbook.

15. (applicable in case of Vishesh Krishi Upaj Yojana only)

a. I/We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which RBI permission has been obtained.

b. I/We hereby undertake that in case of non realisation of export proceeds or lesser realisation of export proceeds in free foreign exchange, I/We shall pay in cash, an amount equivalent to the duty free credit entitlement already obtained on the non-realised basis or lesser realised value of export proceeds together with 15% interest reckoned from the date of imports till the date of deposit.

16. (applicable in case of EO Refixation under EPCG Scheme only)

a. I/We hereby declare that the particulars and the statements made in this application for refixation of export obligation are true and correct to the best of my/our knowledge and belief and nothing has been concealed or held therefrom.

b. I/We full understand that any information furnished in the application if proved incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.

c. I/We further declare that the refixation of export obligation is being sought for the EPCG licence where atleast 50% of the exports indicated in row 6 above have been realised.

d. I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992,the Rules and Orders framed thereunder, the Export and Import Policy and the Handbook of Procedures.

e. That I/We shall be liable to penal action in accordance with the Policy/Procedure/Foreign Trade (Development & Regulation) Act, 1992 the Rules and Orders framed thereunder and the Customs Act, 1962 addition to forfeiture of Bank Guarantee or any other Bond/Guarantee given to the Customs/licensing authority, in the event of failure to fulfill the export obligation as stipulated, within the export obligation period prescribed or subsequently extended by the competent authority.

17. (applicable in case of For Duty Drawback on All Industry Rates/Fixation of Drawback Rates/Refund of Terminal Excise Duty only)

a. I/we further declare that I/We shall immediately refund the amount of drawback obtained by us in excess of any amount/rate which may be re-determined by Government as a result of post verification.

b. I/we further declare that no export proceeds are outstanding beyond the prescribed period as laid down by the RBI, or such extended period for which RBI permission has been obtained.

c. I/we further declare that the goods supplied are not excisable/Goods are excisable but CENVAT/rebate facility is not available to the recipient of the goods.

18. I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 9.9 of the Policy.

Signature of the Applicant Name Designation Official Address Telephone Residential Address Email Address

Place Date

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