1.

The application should be completed in duplicate and submitted to the authorised dealer through whom the documents were negotiated/sent for collection.

2.

Before forwarding an application to Reserve Bank, authorised dealer must properly scrutinise it to ensure that it is complete in all respects.

3.

Wherever applicable, reference number and date of Reserve Banks letter of approval should be quoted in full. Reference to the Exchange Control Manual may also be quoted in full.

4.

Authorised dealers should complete the certificate given at the end of the application.

5.

Original correspondence exchanged with the overseas buyer/correspondent bank, etc. in connection with delay in payment etc.

6.

Bank certificate in case where part proceeds of the shipment have been realised.

1.

Particulars of exporter :

(i)

Name of the exporting firm/company

(i)

(ii)

Address in full

(ii)

(iii)

Importer - exporter code number

(iii)

2.

Full particulars of shipment :

(a)

Name and address of the overseas

(a)

buyer/consignee

(b)

Commodity

(b)

(c)

Quantity

(c)

(d)

Distinctive Number / s of GR/PP form (s).

(d)

(e)

Date of shipment

(e)

(f)

Invoice value

(f)

(g)

Country of destination

(g)

(h)

Terms of payment (specify whether D/P, D/A or L/C etc.)

(h)

3.

Whether goods were shipped on outright sale or consignment basis

4.

(a)

Reasons for non-payment of bill/s.

(a)

(b)

If the goods have remained unsold, present condition/position thereof

(b)

(c)

Steps taken or proposed to be taken by the exporters to realise the export proceeds

(c)

(d)

If the buyer has deposited the sale proceeds with a local bank in the currency of the country to which export has been made, the possibility of externalisation i.e., the time likely to be taken for conversion of the proceeds into foreign exchange

(d)

5.

Particulars of previous approval/s, if

any, for extension obtained from the

Reserve Bank.

6.

Further period for which extension is sought.

7.

In case part payment has been received against the bill in question

(a)

When and how much proceeds realised so far

(a)

(b)

Amount yet to be realised

(b)

(8)

Export performance during last 3 years.

Year

Amount (Rs. )

Exports

made :

1)

2)

3)

Amounts outstanding if any :

1)

2)

3)

9.

Any other information which exporter deems necessary to furnish in support of the request

We declare that the particulars given above are true and correct to the best of our knowledge and belief

Place:

(Signature of Authorised Official)

Date :

Name :

Stamp

Designation:

(The signature on behalf of the firm/company should be that of the senior partner/proprietor or authorised signatory of the exporting firm or company, as the case may be.)

(Signature of Authorised Official)

Name :

Stamp

Designation:

Name and Address

Date:

of Authorised Dealer :

(Space for use of Reserve Bank of India)