APPENDIX - 3 A
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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 )
3. IEC No. ...........Date of Issue ....... Issuing Authority ......
3A. PAN No......................... Issuing Authority ......
4. If the registration is required No. ............... date .....
as a manufacturer exporter
SSI Registration
Industrial Licence/ IEM
Issuing Authority: ...............................
Others (specify) ...............................
5. EH/TH/STH/SSTH/Golden ................. 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 _____________________________________
(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. Name address of the branches, if any __________________________
9. Name and address of the factory __________________________
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10. I/We hereby solemnly declare that the above stated
information is true and correct. I/We undertake,
without any reservation, to :
(a) abide by the terms of the registration
certificate granted to us on all our exports;
(b) agree to abide by any code of conduct that may be
prescribed;
(c) agree to abide by export floor price condition
that may be stipulated by the Registering
Authority;
(d) furnish without fail monthly returns of exports
including nil returns to the Registering
authority by 15th day of the months following the
quarter.
11. 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 : _________________
Designation: __________________
Address : __________________
__________________
Tele No:_________________
Fax No:_________________
E.Mail No:_________________
Residential address:_________________
Place _______________ __________________
Date _______________ E.Mail Address : __________________
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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. Bank certificate in support of the applicant"s financial soundness.