ANF 3A

Application for Grant of Status Certificate

(Kindly see Para 3.10 of FTP)

1. IEC Number

2. Applicant Details

Name

Address

3. RCMC Details

i. RCMC Numberii. Date of Issue

iii. Issuing Authorityiv. Valid upto

v. Products for which registered

4. Category of Status applied for: EH / SEH / TH / STH / PTH

5.
(i) Date of Filing of Application (please feed the date of electronic filing of application) :

(ii) Current Year of Application (please specify the Apr-Mar period) :

6. Details of Exports / Deemed Exports / Foreign Exchange earned for supply of Service from India during preceding 3 licensing years and current year (i.e. year in which application is filed), duly certified by CA/ICWA/CS in annexure attached.

Sl. No.	Year (Please specify the year)	Exports (Rs in Cr) As in Row 6 of Sl. No 6 of Annexure below - CA Certificate (Including Deemed Exports and Foreign Exchange Earned for Supply of Service from India)
1	Current Year (Please see Note 2 below)
2	Previous Year 1
3	Previous Year 2
4	Previous Year 3
5. Total
Note 1: RA to grant status recognition upon Total (as in Row 5) above exceeding the limit given in Para 3.10.2 of FTP. For Export House Status, exports in any two out of above four years shall suffice. Validity of Status Certificate shall be as per Para 3.2.2 of HBPv1 2009-14. Note 2: In case application is filed on basis of current years’ exports, please indicate the specify period (say e.g. Apr-July of Current Year if 4 months exports are counted, or Apr-Nov of Current Year if 9 months exports are counted)

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 (FTDR 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 FTDR 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 and services of my firm / company are true and correct and in accordance with accounts maintained in my firm / company.

5. I hereby declare that details of exports of goods and services of my subsidiary company are true and correct and in accordance with accounts maintained by my firm / company.

6. I hereby declare that a shipment has been included only once in one of the categories eligible for double weightage (Para 3.10.3 of FTP).

7. I hereby declare that exports made on re-export basis have not been included.

8. I hereby declare that export / supplies do not include any disclaimed third party exports, where the realization from overseas is in the name of the third party and not in the name of applicant here. (Note: Such exports can be counted in the third party application for grant of status, if any).

9. I hereby declare that only such exports has been taken into account for seeking recognition, which has been realized by me in our bank account directly from overseas.

10. I undertake to abide by provisions of Para 9.53 of FTP relating to Service Providers rendering services from India.

11. I undertake to abide by provisions of FTDR Act, 1992, Rules and Orders framed thereunder, and the FTP.

12. 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. One Printout of this ANF3A, duly signed in provided space. 2. Copy of Updated Profile in ANF1 only if any changes have taken place and updated.	Official Address: ___________________________ _________________________________________
3. Self certified copy of valid RCMC.	Telephone: _______________________________
4. CAC as per Annexure attached 5. Copy of earlier Status Certificate, if any.	Residential Address: ________________________ _________________________________________
	Email Address: ____________________________

Annexure to ANF 3A

CERTIFICATE OF CHARTERED ACCOUNTANT (CA)

COST AND WORKS ACCOUNTANT (ICWA)/ COMPANY SECRETARY (CS)

I / We hereby confirm that I / We have examined prescribed registers and also relevant records of M/s ....... .............……………………….............................having IEC Number …………………for licensing period (s) …………………………and hereby certify that:

1 Following documents / records have been furnished by applicant firm / company and have been examined and verified by me / us namely: -

a. Statutory documentations under Customs Act 1962 and Excise Act 1848, Service Tax Act, Foreign Trade (Development & Regulation) Act 1992;

b. Export Order / Contract, Shipping Bills, Bill of Lading (and / or Airways Bills / PP Receipts), Customs / Bank attested Invoices, Forward Inward Remittance Certificates (FIRCs) and Bank Certificates of exports and realization, GR declaration and connected books of accounts;

c. FIRCs, Certificate from international credit card companies.

2 Information given by applicant firm / company in ANF 3A is in agreement with FTP 2009-14, as amended, and rules and procedures made thereunder, relevant register and records and books of accounts maintained by M/s .............…………………... and their subsidiaries and is also true and correct.

3 It has been ensured that

a. Information furnished is true and correct in all respects; no part of it is false or misleading and no relevant information has been concealed or withheld;

b. In respect of export of goods, a shipment can counted in applicants export turnover / performance only if the realization of export proceeds from overseas is in the applicant’s bank account.

c. In respect of service providers, realization of export proceeds in free foreign exchange pertains to rendering of services.

4 Neither I, nor any of my / our partners is a partner, director, or an employee of above-named entity, its Group companies or its associated concerns;

Place: ______________	Signature of CA/ ICWA / CS:_______________________
Date: _______________	Name of the Signatory: ______________________
	Address: _________________________________
	Membership No: ___________________________
	Email Address: _________________________________
If any of documents of record mentioned in serial number (i) have not been maintained / furnished, examined or verified, they may please be specified below:- 1) 2)

Annexure to ANF 3A (continued)

5 I / We further certify that export proceeds for shipments during last three years plus current year are not outstanding beyond prescribed period as permitted by RBI.

6 Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service is as under:

Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service from India
Type of Exports (Rs in Cr) (FOB / FOR value / Foreign Exchange Earned)	Current Year	Previous Year 1	Previous Year 2	Previous Year 3
1. Exports without Weightage
2. Exports with Double Weightage* (including Foreign Exchange Earned by Supply of Service from India) (Row 9 in Format A below)
3. FOR value for Deemed Exports (Chapter 8 of FTP)**
4. Exports of Subsidiary Company (Please specify the name and give the proof thereof)
5. Exports of SEZs / EOUs / EHTPs / STPs / BTPs, if clubbing is sought***
6. Total (Rs in Cr)
Note: A shipment can be included only once in one of the categories eligible for double weightage. *- Format A, ** - Format B, *** - Format C-Kindly see these formats as per Annexure 1 below

7 I / We fully understand that any statement made in this certificate, if proved incorrect or false, will render me / us liable to face any penal action or other consequences as may be prescribed in law or otherwise warranted.

Place: ______________	Signature of CA/ ICWA / CS:_______________________
Date: _______________	Name of the Signatory: ______________________
	Address: _________________________________ _________________________________________
	Membership No: ___________________________
	Email Address: _________________________________
If any of documents of record mentioned in serial number (i) have not been maintained / furnished, examined or verified, they may please be specified below:- 1) 2)

Annexure 1 to Annexure to ANF 3A

Format A Certificate of Exports with Double Weightage Note: A shipment is included in one of categories indicated below only once.
Sl. No.	Category of Exports	FOB / FOR / Foreign Exchange Earned (Rs in Cr)
1	Exporters in Small Scale Industry (SSI) / Tiny Sector / Cottage Sector
2	Units registered with KVICs / KVIBs
3	Units located in North Eastern States, Sikkim and Jammu & Kashmir
4	Units exporting handloom / handicrafts / hand knotted or silk carpets
5	Exporters exporting to countries in Latin America / CIS / sub-Saharan Africa as listed in Appendix-9
6	Units having ISO 9000 (series) / ISO 14000 (series) / WHOGMP / HACCP / SEI CMM level-II
7	Foreign Exchange Earned by Supply of Services as per Format A1 below
8.	Total FOB Value (Rs in Cr)
9.	FOB Value of Exports with Double Weightage (Rs in Cr) = [2 * Total FOB Value]
Place: ______________		Signature of CA/ ICWA / CS:_______________________
Date: _______________		Name of the Signatory: ______________________ Address: _________________________________ Membership No: ___________________________ Email Address: _________________________________

Format A1 Certificate of Foreign Exchange Earned by Supply of Service from India to (outside India or In India)
Sl. No.	Category of Service Provider	Sr. No. of Appendix 10 (within each category)	Foreign Exchange Earned (Rs in Cr)
1	Para 9.53 (i)	i)
2	Para 9.53 (ii)	i) ii)
3	Para 9.53 (iii)	i)
4	Para 9.53 (iv)	i)
5.	Total Foreign Exchange Earned by Supply of Service from India (Rs in Cr)
Place: ______________		Signature of CA/ ICWA / CS:_______________________
Date: _______________		Name of the Signatory: ______________________ Address: _________________________________ Membership No: ___________________________ Email Address: _________________________________

Annexure 1 to Annexure to ANF 3A (continued)

Format B Certificate of FOR value of Deemed Exports
Sl. No.	Category of Deemed Exports (Chapter 8 of FTP) (Please quote the relevant sub para in brackets)	FOR (Rs in Cr)
1	e.g. Supply to Advance Authorisation (8.2 (a))
2
3
4
5
6
7.	Total FOR Value (Rs in Cr)
Place: ______________		Signature of CA/ ICWA / CS:_______________________
Date: ______________		Name of the Signatory: ______________________ Address: _________________________________ Membership No: ___________________________ Email Address: _________________________________

Format C Name (s) of SEZs / EOUs / EHTPs / STPs / BTPs and exports thereof, if clubbing is sought for grant of Status
Sl. No.	Names of Exporting Units	FOB (Rs in Cr)
1	SEZs
2	EOUs
3	EHTPs
4	STPs
5	BTPs
6.	Total FOB Value (Rs in Cr)
Place: ______________		Signature of CA/ ICWA / CS:_______________________
Date: ______________		Name of the Signatory: ______________________ Address: _________________________________ Membership No: ___________________________ Email Address: _________________________________