Note: 1. Please read the general instructions given at Appendix 1
before filling this application.
2. In addition to 10 copies of this application form.
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FOR OFFICIAL USE
File No. :-------------------------------- Date :------------------
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PART-I
------
1. Name and address of the Applicant :
2. IEC Number :
2(A). PAN NUMBER :
PART-II
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(To be filled in for export of Special Chemicals in Categories 1B and 1C of
Appendix-3)
3. (i) Item of export
(ii) Quantity applied for
(iii) FOB value per unit
(iv) Total FOB Value
4. Details of the exports of Items under S.No.28 in
preceding three licensing years
| Sl.NO. | YEAR | Name of the item | Licence No. date | Qty. & value in US$ of the Licence | Qty. & value in US$ of the Item Exorted | Name of the end user | Country to which Exported |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| | | | | | | | |
|
5. If applied for export on :
repeat basis in the same
licensing year for same
product and end-use and to
the same end-user, then
following information may
also be furnished
(i) Reference number and :
date vide which the
earlier permission was
granted by this office
(ii) Export licence number :
and date
(iii) Quantity allowed for :
export
(iv) Quantity exported on :
the date of this
application
6. Export Order No. & date :
(Attach copy)
7. Name and full address of the :
buyer
8. Name and full address of the :
end user
9. Port of shipment :
10. Destination of export
(i) Port of Discharge :
(ii) Ultimate Destination :
11. End product for which the :
item of export will be used
by the end user (attach end
user certificate)
12. The purpose for which the end :
product will be utilised
13. If application is for export
of samples, furnish the
following details:
(i) Ceiling limit :
(ii) How much in excess of :
the ceiling limit
(iii) Justification for excess :
PART-III
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(To be filled in for export of all other Category items of Appendix-3
except those covered by Part-II above )
14. Category, item number and :
item name as in Schedule 2
pendix 3 of ITC (HS)
Clasifications of Export and
Import items (Attach technical
specification not exceeding one
page for item, in the order in
which these items have been
listed)
15. (i) Quantity applied for :
(ii)FOB value per unit (US $) :
(iii)Total FOB value (US $) :
16. Importer"s Purchase Order number :
and date (Attach copy)
17. Is the applicant the producer/ :
manufacturer of the item to be
exported? It not, name the
producer/ manufacturer and
provude full address, telephone
No.etc.
18. Details of Export Licences (EL) :
previously applied for items
under Schedule 2 Appendix 3
of ITC (HS) Classificartions of
Export and Import items
| S.No. | Date of application | No.& date of export licence (see Note below) | Items exported & Qty-Value | Date of shipment (attached B/L copy) | Destination Country |
| | | | | | |
___________________________________________________________________________________
*State "denied " if the licence was denied. A false statement ill invite prosecution.
19. Port of Shipment :
(Delhi, Mumbai, Calcutta or
Chennai Identify only one Port)
20. Destination of Export (Country) :
21. Name of the consignee, complete :
postal adress; telephone, fax etc. :
22. Citizenship of consigned (if :
individual)
23. Headquarters address of consignee, :
if corporate office different from
entry at (10) above.
24. (a) Location (country) of end-user :
(b) End product and / or :
end-purpose for which the
exported item will be used
by the end user. (Attach end-use
certificate in the prescribed
proforma)
(c) Name and complete address :
of end-user (include telephone,
fax Nos. etc.)
(d) Is end-user an entity of :
Government of destination :
country?
(e) Manufacturing/Business/ :
Other activity of the end user.
25. Through which banks will the
financial transactions relating
to this export be executed?
(a) In destination country :
(provide full address)
(b) In India
26. Name and address of all :
foreign Collaborators of the
applicant (as registered with
GOT/RBI). If noe, state None.
27. Period during which the item :
is proposed to be exported
from India.
28. If revalidation required :
(a) Period of extension sought :
(b) Reasons therefor
DECLARATION / UNDERTAKING
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I / We hereby solemnly undertake / declare that:-
(i) The particulars and the statements made in this
application and attachments thereto are true to
the best of my / our knowledge and belief and nothing has
been concealed or withheld therefrom.
(ii) If any information furnished in this application is
found to be false, inaccurate, not current or
misleading, any licence granted on the basis of this
application shall be liable to cancellation or being
made ineffective without prejudice to any other action
that may be taken in this behalf under the Foreign Trade
(Development and Regulation) Act, 1992, or rules and
orders made thereunder, and the Customs Act, 1962.
(iii) Any information furnished in the above statement 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.
(iv) 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.
(v) I hereby certify that I am authorised to certify and
sign this declaration as per Paragraph 3.8 of the
Policy.
(vi)I/we further undertake to submit to the DGFT (PC-III Section)a copy of the bill of
entry into the destination state
party within 30 days of delivery failing which I/we shall be liable to action under the
foriegn trade (Development and Regulation)Act 1992,or rules and orders made thereunder
adn the customs acts,1962.
(Above Para after sub para(v) of appendix 18.B has been amended vide
public notice no.15
(RE-2000)/1997-2002 dated 14-6-2000)
Place: Signature of the ----------------------
Applicant
Date: Name in Block Letters ----------------------
Designation ----------------------
Official Address ----------------------
Residential Address ----------------------
Email Address -----------------------
Note: Each page of this application should be signed individually by the Managing
Director, or the Company Secretary or a Director of the firm. If signed by a
Director of the firm, then that Director must be duly authorised to do so by the
Board of Directors of the firm.
This Certificate is to be furnished by the exporters of Categories 1B &1C items of
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Appendix-3
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END USE CERTIFICATE
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( to be furnished with reference to column 11 of this Export Licence Application ).
We ( name of the end user ) , certify that we are importing -----------------M.T of --
------------------ from ( name and address of exporter ) for the manufacture of ------
------------------( State Specific use ) .
We further certify that we will not use the above mentioned chemical for any purpose
other than stated as above nor transfer or re-export the item to any other party /
country for any other purpose.
Place: Signature of end user with Stamp & Seal:
Date Name:
Designation:
Note:- The exporter shall furnish a copy of confirmed export order indicating number and
date to the Customs and DGFT at the time of actual shipment.
(End Use Certificate has been amended vide PUBLIC NOTICE No. 49(RE-98)/1997-2002 DATED
: 14-10-98)
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[old
END USE CERTIFICATE
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(To be furnished with reference to Column 11 of
this Export Licence Application)
We, (name of the end user), certify that we are importing _____ M.T. of ____________ from
(name and address of exporter) against our Purchase Order No. _____ dated ______ for the
manufacture of ______________ (state specific use)
We further certify that we will not use the above mentioned chemical for any purpose
other than stated as above nor transfer or re-export the item to any other party / country
for any other purpose.
Place:
Signature of end-user with Stamp and Seal
Date: Name:
Designation:
Note : The Exporter shall furnish a copy of confirme
d export order indicating number and date to the customs and DGFT at the time of
actual shipment.
This Certificate is to be furnished by the exporters of all other category items
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(except categories 1B & 1C) of Appendix-3
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END USE/END USER CERTIFICATE
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[Read instructions at foot of page]
1. I/We _____________________________ a/ hereby certify that we
are the end-user of ________________________________ b/ to be
imported from ____________________________ c/ against our
Purchase Order No. ______________ dated __________ for the
manufacture of/used for __________________________ d/.
OR
The undersigned, hereby declares that I am duly authorised to
certify that _____________________________________________ a/
are the end-users of the items detailed in their Purchase
Order No. ____________ dated __________ and are importing the
said items from ___________________ c/ for the manufacture
of/used for ___________________ d/.
2. I/We further certify that the items detailed in the referenced
Purchase Order will not be used for any purpose other than the
purpose(s) stated in the Purchase Order, and that such use
will not be changed nor the items modified or replicated
without the prior consent e/ of the Government of India.
3. The end-user shall not himself, or through another, cause the
items, or replicas, or derivatives thereof to be re-transferred/
sold without the knowledge/consent e/ of the
Government of India, to any party within ________________ f/
or outside it.
4. I/We also certify that all the facts contained in this
certificate are true and correct to the best of my knowledge
and belief and that I/we do not know of any additional facts
that are inconsistent with this certificate.
Place:
__________________________________________
Date : Signature of end-user/authorised signatory
of end-user with stamp and seal
Name : ___________________________________
Designation:_______________________________
______________________________________________________________________
Instructions:
a/ Name of end-user as at entry 24(c) of this Export Licence
Application.
b/ Items entries as at Sl. No. 14 of this Application.
c/ Name and address of exporter in India.
d/ Name of the end product/end use.
e/ DGFT will state the condition in export licence. Do
not strike out.
f/ Destination country.