APPENDIX - 3A

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FORM OF APPLICATION FOR REGISTRATION CUM MEMBERSHIP WITH EXPORT PROMOTION COUNCILS

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NOTE:

Please see paragraph 13.8 of the Policy and paragraph 13.3 of this Handbook

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FOR OFFICIAL USE

File No.:----------------------------------------------- Date:-------------------------------------
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To,

The

_______________________________
_______________________________
_______________________________
(Name and Address of the Council)

Dear Sir,

       Kindly register us as Merchant/Manufacturer exporter of the export product(s) mentioned below.

1.	Name of the applicant	:..............................
2.	Address of the applicant (Registered Office in case of limited companies, and the head office for others )	:.............................. :..............................
2A.	Name address of the branches, if any	_________________________
2B.	Name and address of the factory	_________________________ .......................................
3.	IEC No. ....................Date of Issue ...................... Issuing Authority ..................
3A.	PAN No.........................	Issuing Authority ......
4.	If the registration is required as a manufacturer exporter SSI Registration Industrial Licence/ IEM	No. ............... date ......
		Issuing Authority: ............
	Others (specify)	...............................
5.	EH/TH/STH/SSTH/Golden status ............................... Valid upto................................ Certificate no.
5(a)	SEH/ISEH/ISSEH/ISSEH ................................ Valid upto ............................... Certificate No.
6.	Details of Directors/Partners/Proprietor/Karta to be given in the following manner

(1)	(a)	Name	_____________________________________
	(b)	Father"s Name	_____________________________________
	(c)	Residential address	_____________________________________ _____________________________________ _____________________________________
	(d)	Telephone No.	_____________________________________
(2)	(a)	______________________	(3)	(a)	_____________________
	(b)	______________________		(b)	_____________________
	(c)	______________________ ______________________ _____________________		(c)	_____________________ ______________________ _____________________
	(d)	______________________		(d)	_____________________
(4)	(a)	______________________	(5)	(a)	_____________________
	(b)	______________________		(b)	_____________________
	(c)	______________________		(c)	_____________________
	(d)	______________________		(d)	_____________________

7.	Name of export product(s) for which registration is required.	__________________________
8.	I/We hereby solemnly declare that the above stated information is true and correct. I/We undertake, without any reservation, to : abide by the terms of the registration certificate granted to us on all our exports; agree to abide by any code of conduct that may be prescribed; agree to abide by export floor price condition that may be stipulated by the Registering Authority; furnish without fail monthly returns of exports including nil returns to the Registering authority by 15th day of the months following the quarter.
9.	We further understand that our registration is liable to be cancelled in the event of breach of any of the undertakings mentioned above.
		Yours faithfully, (Signature)
	Name	............................
	Address	............................
	Designation	............................
	Tele No:	............................
	Fax No:	............................
	E.Mail Address:	............................
	Residential address:	................................. ...................................... ........................... ............................
Place _______________
Date ____________

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Documents to be enclosed with the application form:

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1. A self certified copy of the IEC Number issued by the licensing authority concerned.
   
   
2. A certificate from the bank in support of the applicant"s financial soundness.