ANF 5B

Statement of Export for Redemption of EPCG Authorisation

1. Applicant Details

i. Name

ii IEC Number

iii. Address

i. EPCG Authorisation Number

Ii. Date of Issue

Iii EPCG File No.

i. Original date

ii. Extended EOP date

iii. Actual EO Completion date:

4. Installation certificate No. & Date

5. Export Product Details:

i. Same / similar product name

ii. Alternate Product name

6. Export Obligation (EO) imposed
		In Indian Rupees	In US $
i.	Average EO +
ii.	Specific EO (on cif / Duty saved amount)

+ In case of alternate product export of average EO of alternate product should be given.

7. Details of physical exports/deemed exports made/services rendered for maintaining specific EO of Authorisation for which this redemption is sought
S No	Products Exported/ Supplied/Services rendered	Shipping Bill/ Voucher/Invoice/ CT 3 / ARE 3/ Lorry Receipt/ Railway Receipt Details +		FOB / FOR value(in FFE) ++
	Same Product/Services ------------------ Alternative Product / Services	No	Date	Direct exports	Third Party exports	Deemed Exports	By Group Company	Other R&D Services/ Royalty	Total

+ not to be filled in by hotel industry

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

8. We further declare that we have made exports as under for maintenance of Average (other than that mentioned in 7 above) Exports

FINANCIAL YEAR	TOTAL VALUE OF EXPORTS (OTHER THAN EXPORTS UNDER THE LICENCE) INR

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 and 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.

2. 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, [Deleted - 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).

(In this appendix the word "2004-09" has been deleted vide PN. NO. 03/2009, DT. 31/08/2009)

2A. I/We hereby certify that our applicant firm/company has NOT availed any benefits under Technology Upgradation Fund Scheme (TUFS), administered by Ministry of Textiles, Government of India, for the capital goods imported under the subject zero duty EPCG authorization.

3. I hereby certify that I am authorized 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

4. It is certified that all physical exports made as shown in item Nos. 7 & 8 above are in freely convertible currency and payment of the same has been realized*.

Signature with Seal of the Chartered Accountant

* In case of ‘Service Provider’ submission of self attested copies of Foreign Inward Remittance Certificate (FIRC) / Bank Certificate alongwith ANF5B shall be mandatory.

Note: Realization of export proceeds shall not be insisted, if the Reserve Bank of India (RBI) writes off the requirement of realization of export proceeds on merits and the exporter also produces a certificate from the Foreign Mission of India about the fact of non recovery of export proceeds from the buyer. However this would not include self write off cases.

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