Note:
1. Please see paragraph 6.2 of this Handbook.
2. Please read the general instructions given at
Appendix-1 before
filling this application.
3. Please submit 15 copies of this application form.
______________________________________________________________________________________________
FOR OFFICIAL USE
File Number:........................ Date:........
_____________________________________________________________________________________________
1. IEC Number : ..................
1(a) PAN Number : ..................
2. Name and address of the applicant : M/s. ..............
............................
3. Application for (Tick the relevant column) :
a) (i) EPCG Scheme on FOB basis : []
(ii) EPCG Scheme on NFE basis : []
b) (i) Manufacturer Exporter : []
(ii) Merchant Exporter : []
(iii) Service Provider : []
4. Category of service provider : []
(If applicable)
5.(i) Name of the end products to
be manufactured out of the :
proposed capital goods.
(ii) Product(s) to be exported
:
(iii)Export Product Group Code
:
6.(i) CIF Value of the licence : In Rs. ...............
applied for. In freely convertible
currency .............
(ii) Export obligation under taken:
(In freely convertible currency) .....................
7. Application fee details : Rs. ......................
Bank Receipt / DD No. ......
and date
Issued by ...............
8.i) Name of the applicant or his : .....................................
supporting manufacturer (s) / ......................................
vendor (s) and Address of ......................................
factory where the capital
goods to be imported are
proposed to be installed
ii) The manufacturing products
endorsed on SSI / Industrial
Licence / IEM.
iii) Whether any export Yes / No.
obligation has been imposed
in the Letter of Intent /
Industrial Licence / FC
Approval If yes, give details thereof ......................................
including E.O fulfilled, if any:
9.Capital investment on fixed assets :
Existing Proposed
-------- --------
A. Land and Building Rs. .......... Rs. ........
B. Machinery / Equipments
----------------------
(i) Imported (CIF Value) Rs........... Rs. ..........
(ii) Indigenous Rs. .......... Rs. ..........
(iii) CIF value of CG
applied for Rs. .......... Rs. ..........
(iv) Total of (i)+(ii)+
(iii) Rs. .......... Rs. ..........
Total : Rs. .......... Rs. ..........
___
10A Any change in the status of : (a) Not applicable / |___|
SSI limit due to import of ___
capital goods proposed to be (b) No change / |___|
imported under this scheme ___
(c) Crosses SSI limit|___|
(please tick the relevant one)
10B. Whether the firm has any confirmed :
Commitment from any foreign buyer
for exports,if yes, give details
11. Details of exports made / services rendered for the same on similar export
product during preceding three licensing years.
| LICENSING YEAR | FOB VALUE OF EXPORTS
(in Rs.) | PRODUCTS EXPORTED |
| | | |
12.Customs duty on Capital goods
to be imported | Duty leviable under
EPCG scheme | Duty Saved (in Rs.) |
| | | |
13. Details of EPCG Licences already obtained:
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Sl. Licence No. CIF Value Export Whether BG/ %agre of
No. and date (in Rs.) obligation LUT submitted export
fixed in obligation
freely fulfilled
convirtible
currency
--------------------------------------------------------------------------------------
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14. Details of capital goods applied for import :
----------------------------------------------------------------------------------------
S.No Description and technical Quantity CIF Value in Freely convertible
specification of the currency(FOB+Frieght+Insurance)
items of import.
-----------------------------------------------------------------------------------------
(1) (2) (3) (4)
-----------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------
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Country of origin Nature of items of import
(State whether capital goods / jigs
fixtures / dies / moulds / spare parts)
-----------------------------------------------------------------------------------------
(5) (6)
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DECLARATION / UNDERTAKING
--------------------------------
I / We hereby solemnly undertake / declare that:-
(i) 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.
(ii) I / We full 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.
(iii) 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.
(iv) That I / We shall be liable to penal action in accordance
with the Policy / Procedure / Foreign Trade (Development &
Regulation) Act, 1992 the Rules and Orders framed
thereunder and the Customs Act,1962 addition to
forfeiture of Bank Guarantee or any other
Bond / Guarantee given to the Customs, in the event of
failure to fulfil the export obligation as stipulated,
within the export obligation period prescribed or
subsequently extended by the competent authority.
(v) 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.
(vi) I hereby certify that I am authorised to verify and
sign this declaration as per Paragraph 3.8 of the
Policy.
Signature of the Applicant :..............
Name : .................
Designation : .................
Official Address : .................
.................
Tele.No. :
Place : Residential Address : .................
Date : .................
E-Mail Address : .................
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Documents to be enclosed with the application form:
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1. Bank Receipt (in duplicate) / Demand Draft evidencing payment of
application fee in terms of Appendix-34.
2. Self certified copy of the Proforma invoice/quotations of the foreign
supplier showing separately (i) the amount on account of freight and (ii)
insurance included in the CIF value quoted. In case the Proforma invoice is
on FOB basis,the applicant shall indicate the freight and insurance separately
in the application form.
3. Manufacturers illustrated pamphlets / catalogue.
4. Statement of exports achieved by the applicant in respect of the
same / similor export product / services redered during the preceeding
three licensing years duly certified by a Chartered Accountant / Cost and
Works Accountant in the form given in Appendix-26.
5. (a) Self certified copy of SSI registration certificate / Industrial
Licence / Letter of intent or I.E.M. acknowledgement filed with the
Secretariat for Industrial Assistance.
OR
(b) In case of service provider, a proof indicating the profession to
which the applicant belongs.