1. Please see paragraph 7.3 of the Policy and Paragraph 7.2, 7.3, 7.4, 7.5 and 7.11 of this Handbook (Vol.I). 2. Please read the general instructions given at Appendix 1 before filling this application. 3. Please submit 2 copies of this application ( 10 copies if no Standard input- output norms are fixed) -------------------------------------------------------------------------------------- FOR OFFICIAL USE File Number:---------------------------- Date:-------------- -------------------------------------------------------------------------------------- 1. Name and address of the applicant : ........................ ........................ ........................ 2. (a) I.E. Code No. : ...................... (b). PAN Number : ...................... 3. (a) Name and address of the manufacturer /....................... supporting/co-manufacturer: ....................... ....................... (b) Type of .......... Registration............ Date........... unit No. 4. Total FOB value of Rs. ........ in currency ...........in US $ ...... exports excluding of exports commission: 5. Total CIF value of Rs. ........ in currency .......... in US $ ...... imports: of exports 6. Value addition: 7. Application fee: a)Bank Receipt / D.D No.and date............ b)Issued by ............................. 8. Port of Registration: ...................... 9. Sr.No. of Standard Input-Output Norms:...................... 10. Export Product Group: ...................... 11. Supply Order No.......... Date........... (Applicable for Advance Licence for intermediate supply and Advance Licence for deemed exports) 12. Name and address of the :...................... Project Authority / Ultimate Exporter 13. Delivery period of supply :.................... 14. If the application is for Advance Licence for deemed export;indicate: i) credit under which Project is financed .................... ii) method by which the order is procured .................... (International Competitive Bidding etc.) 15. Explain the process of manufacturing activities involved with the help of a flow chart in manufacturing the resultant product (s) against this application.(in case Standard Input Output norms are not fixed) 16. Details of outstanding export obligation against Advance Licence , duty free Licences / pre-export DEPB issued under Duty Exemption Scheme.

S.no	Licence No and Date	CIF value	FOB value	Percentage of export obligation fulfilled		Date of expiry of export obligation period
				Quantity wise	value wise

17. Details of the products to be exported / supplied (Resultant Products).

S. No	Resultant product(s)		Total Quntity	Unit of measurement		FOB Value
	Name,Technical Characterists and Quantity	ITC(HS)Code		Name	Code	In rupees	In freely convertible currency(FCC)

18. Details of items sought for import:

S. No	Required inport items			Quntity required per unit of resultant product	Purpose of requirement	Wastage claimed (%age)	Recoverable wastage/by product
	Description	Technical characteristics	ITC(HS) Code				Name	Quantity	Value

* Purpose of requirement should be indicated against each item whether the same is required as raw material, components, solvents, catalysts, packing material etc. 19. Details of Items sought to be Imported Duty free (Arranged Item wise) ----------------------------------------------------------------------------------------- S. No. Import item Total Unit of measurement ______________________ quantity _______________________ Name ITC(HS) Name Code technilcal Code character- istics & Quality ---------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- --------------------|----------------------|-------------------------------------------- Per unit CIF value | Total CIF value | Total exemption from Customs duty --------------------|----------------------|-------------------------------------------- In In Free | In In Free |Basic Surcharge Additional SAD Rupees Froegin | Rupees Froegin |Costoms Costoms Exchang | Exchang |Duty Duty ----------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- 20. Details of other materials to be used in resultant product and sought to be imported / procured from sources other than the licence on which drawback benefits is to be availed.

S. No.	Resultant product(s) (Name Technical characteristics and quality)	Total quantity	Imported Item			Indigenously procured item
			Name Technical Characteristics and Quality	Quantity and unit of measurement	CIF Value	Name Technical Characteristics and Quality	Quantity and unit of measurement	Value

DECLARATION / UNDERTAKING ------------------------------ 1. 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 held therefrom. 2. I / We fully understand that any information furnished in the application 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. 3. I / We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, the Rules and Orders framed thereunder, the Export and Import Policy and the Handbook of Procedures. 4. I / We further declare that no export proceeds are outstanding beyond the prescribed period as laid down by the RBI, or such extended period for which RBI permission has been obtained. 5. I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 3.8 of the Policy. 6. I/we hereby declare that in respect of product for which Standard Input Output norms are not fixed, we shall abide by the final fixation of norms by ALC and shall pay to the Government Customs duty together with 24% interest on the unutilised inputs as per norms fixed by ALC. We shall also surrender SIL as per paragraph 7.28 A(ii)(b) of Handbook of Procedures (Vol.1) (Applicable for licences under paragraph 7.5 only) Place : Signature of the Applicant : ................. Date : Name : .................. Designation : .................. Official address : .................. ................... Tele No : .................. E-Mail Address .................... Chartered Engineer Certificate ------------------------------- (This certificate is not required when the application is based on the Standard Input Output Norms I have examined the applicant company"s import requirements of raw materials, components etc with regard to their technical description / specification and the quantity against each item of import and having regard to proper technical norms of consumption and after technical scrutiny of relevant designs and drawings, I hereby certify that they are correct in all respects and are actually required for the execution of the export contracts for.............. The list of Items covers ..... pages and contains ..... items for a total value of Rs.......... (in free foreign exchange .........) Signature ................................ Name in Block letters .................... Designation .............................. Address ................................. .................................. Place .......... Name and Address of the Institution :..................... under which Chartered Date ........... Ref No. and date of Corporate :.................... Membership -------------------------------------------------------------------------------------- Documents to be enclosed with the application form: -------------------------------------------------------------------------------------- 1. Bank Receipt (in duplicate) /Demand Draft evidencing payment of application fee in terms of Appendix-34. 2. Project Authority Certificate in cases application for Advance Licence for deemed export and a copy of invalidation letter in case of application for Advance Licence for intermediate supply.