ANF 3C

Common Application Form for VKGUY, FMS and FPS (including MLFPS)

For Exports made on or after 27.8.2009

(Kindly see Paras 3.13.1, 3.13.2, 3.13.3, 3.14, 3.15 of FTP and Para 3.7, 3.8, 3.8.1, 3.8.2, 3.9, 3.9.1 and 3.9.2 of HBPv1)

(Please note that separate applications are required to be filed for separate years (AM10, AM11 etc.) based on date of export. Please note that application has to be filed port-wise. One application cannot cover shipment from more than one port, whether EDI or Non-EDI port.)

1. IEC Number of Applicant:
2. Applicant Details
i. Name
ii. Address
3. RCMC Details
i. RCMC Number	ii. Date of Issue
iii. Issuing Authority	iv. Valid upto
v. Products for which registered
4. Application Details: (i) Export Licensing Year (pl. specify the year in which export has been made, based on date of export (Para 9.12 of HBPv1): (ii) Date of filing of Application: (iii) Port of Export for this Application:
Note: Applicant to feed in the details of one shipping bill at a time and thereafter select the ‘Scheme Name’ under which benefit for a particular shipping bill is being claimed. A maximum of 50 shipping bills can be filed in one application. For each shipping bill, the appendices details will appear after selecting the scheme name. The Scheme Names and relevant appendices are: VKGUY-Appendix 37A, FMS-Appendix 37C, FPS-Appendix 37D, MLFPS –Appendix 37D.
5. Details of Exports

Shipping Bill Details
Sl No	Number	LEO Date	Date of Export*	ITC (HS) code	Item Description	FOB value of Exports (in free foreign exchange)	Foreign Agency Commission (FAC)	For conversion to Rupees, Customs Rate of Exchange, on LEO date	FOB Value (including up to 12.5% FAC) as per Shipping Bill, in Rupees
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10) (10) = (9) * [(7)- {(8) - 12.5%*(7)} if (8) is more than 12.5% of (7)]

Scheme Specific Details						Entitlement
Scheme Name	Relevant Appendix Details	Rate of Entitlement	Details of Focus Market / Linked Market for MLFPS-Market Name	Entitlement Amount (in Rs.)	Late Cut applicable, if any (in Rs.)	(in Rs.)
(11)	(12)	(13)	(14)	(15)	(16)	(17)
				(15) = (10)X(13)		(17) = (15)-(16)

5. Date of Realization of Export Proceeds (in case where application is filed on post realization basis):

(Kindly feed the date and enclose the BRC/FIRC along with the application. In cases of Pre-Realization filing of application, monitoring of such cases will be diligently done by RA concerned)

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

(Splits Certificates shall not be allowed for Duty Credit Scrip issued for exports from Non-EDI ports)

7. Port of Registration (for the purpose of imports)***:

Note: No supplementary cut (Para 9.4 of HBPv1) shall be imposed, as multiple applications have to be filed.
(* Date of Export shall be as per Para 9.12 of HBP v1.)
(** In case of multiple dates of realization against a shipment, the last date of realization is to be mentioned in this column.)
(*** The port of registration shall be the port of export.)

8. Application Submission Details (in case of electronically submitted applications)
i. ECOM Reference Number	iv. File Number
ii. Date of Submission on Server	v. Date of Issue
iii. Submitted to which Regional Authority

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. Consequentially, 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 of my firm / company are true and correct and in accordance with accounts maintained in my firm / company.

5. I hereby declare that no benefit under VKGUY (Para 3.13 of FTP) or Focus Market Scheme, or Focus Product Scheme (FPS) (including for Market Linked Focus Products), as the case may be, was availed (or applied for) previously against Shipping Bills currently included in this application.

6. I hereby declare that in terms of Para 3.17.8 of FTP, this application does not contain any export for which benefit under any other reward/incentive schemes (i.e. VKGUY (including Agriculture Infrastructure Incentive Scrip) - Para 3.13, FMS-Para 3.14, FPS (including MLFPS)-Para 3.15) of Chapter 3 of FTP has been / will be claimed.

7. I hereby declare that in terms of Para 3.17.10 of FTP, this application does not contain any exports in contravention to this provision.

8. I hereby declare that the Exported Product is covered under relevant Appendix and the exports, for which this application is being filed, are made on or after the respective admissible date of export, as indicated in relevant Appendix.

9. I hereby declare that export product for which the duty credit scrip benefit is being claimed does not contain any shipment made w.e.f 27.8.2009 (as per Para 3.17.2 of FTP) from the following ineligible export categories / sectors:

a. EOUs / EHTPs / BTPs who are availing direct tax benefits / exemption;

b. Export of imported goods covered under Para 2.35 of FTP;

c. Exports through transshipment, meaning thereby that exports originating in third country but transshipped through India;

d. Deemed Exports

e. Exports made by SEZ units or SEZ products exported through DTA units; and

f. Items, which are restricted or prohibited for export under Schedule-2 of Export Policy in ITC (HS).

10. I hereby declare that the exports, for which benefit is being claimed under FMS (Para 3.14 of FTP), does not include any export and / or category covered under Para 3.14.3 of FTP.

11. 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. Export promotion (EP) copy of Shipping Bill (or Bill of Export, including in case of exports through Land Customs)	Official Address: _____________________ ___________________________________
2. In cases of Post-realization, Relevant Original Bank Certificate of Exports and Realisation - Appendix 22A / Foreign Inward Remittance Certificates (FIRC) or offsetting of export proceeds with approval of RBI (Appendix 22D). 3. In case the application is filed without BRC, the application shall be accompanied with BG / LUT in terms of Paragraph 2.20 of the HBPv1. 4. Disclaimer in terms of Para 3.17.10, in case the duty credit scrip benefit is being claimed by the supporting manufacturer. 5. For FMS and MLFPS, additionally the Market / Linked Market information will be required to be filled in, and Proof of Landing as per Para 3.8.2 of HBPv1 would also be required.	Residential Address: __________________ ___________________________________
Note: In case of FIRC, a declaration from exporter that remittance is in respect of Shipping Bill(s) No ____________ dtd _________ shall also be furnished.	Telephone: _________________________
Note 1: Each individual page of application has to be signed. One copy of ANF3C duly signed in the provided space. Copy of Updated Profile in ANF1 only if any changes have taken place and updated, along with copy of Valid RCMC.	Email Address: ______________________
Note 2: In cases where original EP copy of Shipping Bill(s) (Bill of export) and/or Bank Realisation Certificates has been submitted under any other scheme of FTP, a self attested photocopy(s) of the same be attached, quoting Reference File no. & concerned Regional Authority / Customs Authority where original documents have been submitted.