APPENDIX - 1A
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PROFILE OF EXPORTER/ IMPORTER
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FOR OFFICIAL USE
File No.:-------------------------------- Date:-----------------
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1. Name of the applicant :...................................
2. Address of the applicant :...................................
(Registered Office in :...................................
case of limited companies, :...................................
and Head Office :...................................
for others )
Tele No.:...........................
Fax No :..........................
E.Mail No..........................
--- --- --- --- --- --- --- ---
3. Date of establishment of | | | | | | | | |
business/factory in India --- --- --- --- --- --- --- ---
d d m m y y y y
4. IEC No. ...........Date of Issue ....... Issuing Authority ............
5. (1) Merchant Exporter(2)Manufacturer Exporter(3)Service provider
(4) Others(please specify) .....................................
6. Permanent Account Number (PAN) of Income Tax .....................
Issuing Authority .....................................................
7. | Category of manufacturing licence | Number | Date | Issuing authority |
| SSI Registration | | | |
| Industrial licence/ IEM | | | |
| Others (specify) | | | |
|
8.EH/TH/STH/SSTH/GoldenCertificate No. ......Date ......Valid upto ..........
8(a) SEH/ISEH/ISSEH/ISSEH No. ............. Valid upto .............
Certificate
9.Nature of the applicant firm : .............................
[1] Government undertaking [2] Public Limited Company
[3] Private Limited Company [4] Proprietorship
[5] Partnership [6] Others (please specify)
10. Details of the main Banker Name of the firm ..............
and Bank Account Address........................
Type of Account ...............
Account No. ...................
11. RCMC No. ........................ Date of Issue ...................
Valid upto ...................... Issuing Authority ...............
12. Details of Directors/Partners/Proprietor/Karta to be given in
the following manner:
(1) (a) Name ......................................
(b) Father"s Name ......................................
(c) Residential address ......................................
(d) E. Mail address ......................................
(e) Telephone ......................................
(Note):Attach extra sheet wherever required)
Place: ....... Signature of the Director/Partner
Proprietor/Karta .............
Date:......... Name .........................
Designation ........................