1. Name of the applicant and
Importer and Exporter Code(IEC) number

2. E-mail address of the applicant

3. Mobile No, office land line no of the applicant

4. Name of the person with designation who will appear for PH

5. Subject matter on which relaxation /intervention is required

6. Reasons for seeking such relaxation/intervention with Justification for reconsideration of request

7. Date, File No & gist of decision against which PH is being sought

8. The date when this decision was reviewed by PRC/ competent Authority

9. Reason of rejection by PRC/Authority/officer

10. Preferable date for PH(2nd Tuesday of every month is earmarked for PH)

11. How many pages of documents are being enclosed?
(Documents enclosed must be duly indexed & pages are numbered)

13. Amount of Fee………………….Mode of payment…………………….

Declaration/Undertaking

1. I/we hereby declare that the information submitted here above is correct and true to best of my knowledge.

2. I/we shall abide by the order/decision of DG taken after affording personal hearing to me/us.
 

Name of the Applicant...................
Designation.............................

Date:
Place: