Note: Please see Paragraph 7.21 of this Handbook. -------------------------------------------------------------------------------------- FOR OFFICIAL USE File No.:-------------------------------- Date:-------------------------- -------------------------------------------------------------------------------------- 1. Name and address of Licensee : ................................................ 2. (a) I.E.C Number .................................................. (b) PAN number .................................................. Licence No........................ Date ....................... DEEC No. ....................... Date ....................... 3. (a) Original CIF value: ......... (a) Proposed CIF value:........... (b) Original FOB value: ......... (b) Proposed FOB value:........... (c) Original value addition (%): (c) Proposed value addition(%): 4.

4.	Items of import	Sr.no in Part C of DEEC Book	Unit Code	Balcony qty to be Imported	Balance CIF value available
1	2	3	4	5	6

5. CIF value of inputs:

S. No.	At the time of application	Revised	On account of cost of input
1. 2. 3.
	Total:........	Total:........	Total:........

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. Place : Signature of the Applicant:.............. Date : Signature of the Applicant:.............. Name: ................. Designation: ................. Official Address: ................. ................. Place : Tele.No.: Date : Residential Address: E.Mail Address.................. -------------------------------------------------------------------------------------- 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. Import Licence in original. 3. DEEC Book (Part I) and (Part II) in original