ANF 5C

(For EO Refixation under EPCG Scheme)

i. IEC Number

ii Date of issue

iii Issuing Authority

2. Applicant Details

i Name

ii Address

File No.		Date
3.	Block year of Export Obligation fulfillment:	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.	Export 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 total exports to be made
6.	Details of EPCG Authorisation presented for refixation of export obligation:

S. No.	EPCG Authorisation 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 export 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 Authorisation =2*(10)*(8)/100 for cases where the remaining EO is less than 2 years on the date of application for refixation

DECLARATION/UNDERTAKING

1. 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 and 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.

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

3. That I/We shall be liable to penal action in accordance with the Policy/Procedure/Foreign Trade 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.

4. 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

GUIDELINES FOR APPLICANTS
1. Two copies of the application must be submitted unless otherwise mentioned.

2. Each individual page of the application has to be signed by the applicant.

3. Application must be accompanied by EPCG authorisation in original.

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

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