APPENDIX - 3 B
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FORM OF REGISTRATION-CUM-MEMBERSHIP CERTIFICATE
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Note: Please see Para 4.10 and Para 13.8 of the Policy and Para 13.3 of this Handbook
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PART I
(To be filled in by the applicant)
1. Name and address of the applicant :_______________________________
2. IEC Number :_______________________________
2(A) PAN Number : _____________________________
3. Address of the Head Office :_______________________________
_______________________________
(i) Registered
Office :______________________________
(ii) Branch(s) :_______________________________
(iii) Factory(s) :_______________________________
4. Year of establishment :_______________________________
5. Description of export product(s)
for which registration is sought :_______________________________
6. Whether registration is required
as merchant exporter or manufacturer
exporter :_______________________________
7. Name of the Proprietor/Partners/
Directors/Managing director :_______________________________
I/We hereby declare that the above information is correct to the best of my/our knowledge and
belief. I/We also undertake to abide by the conditions subject to which registration/membership
is granted.
(Signature)
Name in Block letters _________________________
Designation _________________________
Residential Address___________________________
___________________________
Place _______________
Date _______________
PART - II
(TO BE FILLED IN BY THE REGISTERING AUTHORITY)
This is to certify that M/s____________(Name and address of the firm) is registered with us.
Other details as per our records are as under:
(i) Description of goods for which registered _____________________
(ii) Registration number _____________________
(iii) Manufacturer exporter or merchant exporter* _____________________
(iv) Name(s) of proprietor/
partner(s)/director(s)/ ________________________
Karta (s)
This certificate is issued subject to the conditions laid down in the relevant scheme of
registration of this council.
(Signature of the competent
officer of the E.P. Council)
Name _________________
Designation _________________
Seal ________________
Valid/renewed upto __________ Date of issue _________________
*State clearly whichever is applicable
Space for endorsement of any amendments in this certificate