Note: Please state ‘Not Applicable’ wherever the information/data is not applicable to you.

1. IEC details:

i. IEC Number:

ii. Date of Issue and Issuing Authority:

2. Applicant firm’s details:

i. Name of the entity:

ii. Address (Registered Office in case of Companies and Head Office in case of Others):

iii. Landline no. if any:

iv. Mobile number:

v. e-mail id/ website address:

vi. Nature of the Concern: Proprietorship/Partnership /Limited Liability Partnership/Private limited/ Public Limited/Govt. undertaking/Section 25 Company/Registered Society/Trust/HUF

vii. Preferred Activities: Merchant Exporter/Manufacturer Exporter/Service Provider/ Others

viii. Bank Account details of the applicant’s entity:

ix. PAN Details of the Entity:

x. LLPIN/CIN/Registration no. (if applicable):

Part B: Branch details

i Number of Branches:

Ii Address of Branches , Divisions, units, factories :

3. Details of Proprietor/Partners/Directors/Karta/Trustee of the applicant firm:

i. Name as in PAN (Mr/Mrs):

ii. Father’s Name:

iii Date of Birth (DD/MM/YYYY):

iv Residential Address:

v. Mobile Number:

vi. PAN :

vii.DIN(if applicable):

viii. Aadhar Card Number:

4. Industrial Manufacturing Registration Details:

i. SSI/EM/LOI or IL Registration No./any other document to prove a manufacturer status:

ii. Date of Issue and validity/ Issuing Authority:

iii. Products for which Registered:

5. Service Tax Registration Details (in case of Service providers):

i. Service Tax Registration No/ Issuing Authority :

ii. Services for which registered:

6. RCMC details:

i. RCMC no. / Issuing Authority :

ii. Date of Issue and validity:

iii. Products for which registered:

7. Status House Details (Please tick) – One Star/Two Star/Three Star/Four Star/Five Star:

i. Certificate number/ Issuing Authority:

Ii Date of issue and validity

8.Central Excise Registration No./ Issuing Authority:

9. VAT Registration No./ Issuing Authority:

10. Turnover Details for the preceding three financial years:
 

1. I/We hereby certify that :

B. none of the Directors / Partners / Proprietor / Karta / Trustees of the company /firm /HUF/Trust, (as the case may be), is/are a Director(s) / Partner(s) / Proprietor / Karta / Trustee in any other Company/ firm / entity which is on the Denied Entity List (DEL) of DGFT;
C. neither the Registered Office of the company / Head Office of the firm / 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;
D. we have not obtained nor applied for issuance of an Importer Exporter Code Number in the name of our Registered / Head Office to any other Licensing Authority
2. I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, as amended from time to time, the Rules and Orders framed there under, the Foreign Trade Policy, the Handbook of Procedures and the ITC (HS) Classification of Export & Import Items.

3. I/We fully understand that if any information furnished in the application is 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.

4. 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 withheld therefrom.

5. I hereby certify that I am authorized to verify and sign this declaration as per Paragraph 9.06 of the Foreign Trade Policy.