I / We hereby confirm that I / We have examined the prescribed registers and also the relevant records of M/S __________ for the period ________ and hereby certify that: (i) M/S. _____________________ (full name and address of the applicant) have made the following exports in the preceding three licensing years:

Year	Export product	FOB value

(ii) The following documents / records have been furnished by the applicant and have been examined and verified by me / us namely :- Export order / Contract, shipping bills, Bill of Lading (and / or Airways Bills / Receipts). Customs / Bank attested Invoices, Bank Certificates of exports showing exports made and export proceeds realised in freely convertible currency in their own name and connected books of accounts. (iii) The relevant registers have been authenticated under my / our seal / signature. (iv) The financial information given in the above statement is in agreement with the relevant register and records; the same has been incorporated in the books of accounts maintained by the exporter; and is also true and correct. (v) It has been ensured that the information furnished is true and correct in all respect; no part of it is false or misleading and no relevant information has been concealed or withheld; (vi) Neither I, nor any of my partners is a partner, director, or an employee of the above-named entity or its associated concerns; (vii) I / We fully understand that any statement made in this certificate, if proved incorrect or false, will render me / us liable for any penal or other consequences as may be prescribed in law or otherwise warranted. (Signature and Stamp / Seal of the Signatory) (Chartered Accountant / Cost & Works Accountant) Name of the Signatory : Place: Full Address : Date: Membership No. : If any of the documents or record mentioned in item (ii) of the certificate have not been maintained / furnished, examined or verified, they may please be specified below:- NOTE: Whenever CA certificates has been specified in any paragraph of the policy/ Handbook (Vol.1), CA/cost and work Accountant certificate may be furnished by the applicant as per the performa given above.