ANF 3A
Application for Grant of
Status Certificate during 2008-09
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1. IEC Number |
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2. Applicant Details |
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Name |
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Address |
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3. RCMC Details |
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i. RCMC Number |
ii. Date of Issue |
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iii. Issuing Authority |
iv. Valid upto
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v. Products for which
registered |
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4. Category of Status
applied for: EH / SEH / TH / STH / PTH |
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5. Details of Exports
/ Deemed Exports / Foreign Exchange earned for supply of Service from India
during preceding 3 licensing years and current year (i.e. year in which
application is filed), duly certified by CA/ICWA/CS in annexure
attached. |
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Sl. No. |
Year (Please specify the
year) |
Exports (Rs in Cr) As in Row 6 of Sl. No
6 of Annexure below - CA Certificate (Including Deemed
Exports and Foreign Exchange Earned for Supply of Service from India) |
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1 |
Current Year (2008-09)
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2 |
Previous Year 1 |
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3 |
Previous Year 2 |
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4 |
Previous Year 3 |
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5. Total |
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Note 1: RA to grant
status recognition upon Total (as in Row 5) above exceeds limit given in Para
3.5.2 of FTP. For Export House Status, exports in any two out of above four
years shall suffice. Validity of Status Certificate shall be as per Para
3.2.2 of HBP v1. Note 2: In case application is filed on basis of current years’
exports, please indicate the specify period (say e.g. Apr – July 2008 if 4
months exports are counted, or Apr – Nov 2008 if 9 months exports are
counted) |
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Declaration/Undertaking
1. I hereby declare that particulars and statements made
in this application are true and correct and nothing has been concealed or held
therefrom. I fully understand that any information
furnished in application if found incorrect or false will render my firm /
company and me liable for any penal action or other consequences as may be
prescribed in law or otherwise warranted.
2. I hereby certify that none of
Proprietor/ Partner(s) / Director(s) / Karta / Trustee of firm / company, as
the case may be, is a Proprietor / Partner(s) / Director(s) / Karta / Trustee
in any other firm / company which has come to adverse notice of DGFT. I further
declare that under Foreign Trade (Development and Regulation) Act (FTDR Act)
1992, my firm / company have not been debarred in person from undertaking any
export import business or activity by way of suspension or cancellation of IEC
number. [If so debarred under FTDR Act, details of said order and period for
which the same is operational may be provided].
3. I hereby certify that my firm /
company has not defaulted from export obligation under
any provisions of FTP and has not been placed under the Denied Entity List
(DEL). [If under DEL List, kindly furnish details of order, current status
etc.]
4. I hereby declare that details of
exports of goods and services of my firm / company are true and correct and in
accordance with accounts maintained in my firm / company.
5. I hereby declare that details of
exports of goods and services of my subsidiary company are true and correct and
in accordance with accounts maintained by my firm / company.
6. I hereby declare that a shipment
has been included only once in one of the categories eligible for double weightage.
7. I hereby declare that exports
made on re-export basis have not been included.
8. where the realization from overseas is in the name of the
third party and not in the name of applicant here. (Note: Such exports can be
counted in the third party application for grant of status, if any). I hereby declare that export /
supplies do not include any disclaimed third party exports,
9. I hereby declare that only such
exports has been taken into account for seeking recognition, which has been
realized by me in our bank account directly from overseas.
10. I undertake to abide by
provisions of Para 9.53 of FTP relating to supply of service from India.
11. I undertake to abide by provisions
of FTDR Act, 1992, Rules and Orders framed thereunder,
and the FTP.
12. I hereby certify that I am
authorized to verify and sign this declaration as per Paragraph 9.9 of FTP
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Place: ____________ |
Signature: ________________________________ |
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Date: _____________ |
Name:
___________________________________ |
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Documents to be submitted |
Designation:
______________________________ |
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1. One Printout of this
ANF3A, duly signed in provided space. 2. Copy of Updated Profile in
ANF 1only if any changes have taken place and updated. |
Official Address:
___________________________ ______________________________________ |
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3. Self certified copy of
valid RCMC. |
Telephone:
_______________________________ |
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4. CAC as per Annexure
attached 5. Copy of earlier Status
Certificate, if any. |
Residential Address:
________________________ _______________________________________ |
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Email Address:
_________________________ |
Annexure to ANF 3A
Certificate of Chartered
Accountant (CA)
Cost and Works
Accountant (ICWA)/ Company Secretary (CS)
I / We hereby confirm that I / We have examined prescribed
registers and also relevant records of M/s ………………………………having IEC Number
……………………... for licensing period (s) …… …………………………and hereby certify that:
1 Following documents / records have been furnished by applicant
firm / company and have been examined and verified by me / us namely: -
a. Statutory documentations under Customs Act 1962 and Excise Act
1848, Service Tax Act, Foreign Trade (Development & Regulation) Act 1992;
b. Export
Order / Contract, Shipping Bills, Bill of Lading (and / or Airways Bills / PP
Receipts), Customs / Bank attested Invoices, Forward Inward Remittance
Certificates (FIRCs) and Bank Certificates of exports and realization, GR
declaration and connected books of accounts;
c. FIRCs,
Certificate from international credit card companies.
2 Information
given by applicant firm / company in ANF 3A is in agreement with FTP 2004-09,
as amended, and rules and procedures made thereunder,
relevant register and records and books of accounts maintained by M/s .........
..…………………... and their subsidiaries and is also true and correct.
3 It has
been ensured that
a. Information
furnished is true and correct in all respects; no part of it is false or
misleading and no relevant information has been concealed or withheld;
b. In respect of export of goods, a shipment can counted in
applicants export turnover / performance only if the realization of export
proceeds from overseas is in the applicant’s bank account.
c. In respect of service providers, realization of export proceeds
in free foreign exchange pertains to rendering of services.
4 Neither I, nor any of my / our partners is a partner, director,
or an employee of above-named entity, its Group companies or its associated
concerns;
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Place: ______________ |
Signature of CA/ ICWA /
CS:_____________________ |
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Date: _______________ |
Name of the Signatory:
___________________ |
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Address:
_________________________________ |
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Membership No:
___________________________ |
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Email Address:
_________________________________ |
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If any of documents of record
mentioned in serial number (i) have not been
maintained / furnished, examined or verified, they may please be specified
below:- 1) 2) … |
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Annexure to ANF 3A
(continued)
5 I / We further certify
that export proceeds for shipments during last three years plus current year
are not outstanding beyond prescribed period as permitted by RBI.
6 Statement of Exports / Deemed Exports / Foreign Exchange Earned
by Supply of Service is as under:
Statement of Exports / Deemed Exports / Foreign Exchange Earned
by Supply of Service from India
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Type of Exports |
Current Year |
Previous Year 1 |
Previous Year 2 |
Previous Year 3 |
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1. Exports without Weightage |
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2. Exports with Double
Weightage* (including Foreign Exchange Earned by
Supply of Service from India) |
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3. FOR value for
Deemed Exports |
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4. Exports of
Subsidiary Company |
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5. Exports of SEZs /
EOUs / EHTPs / STPs/ BTPs, if clubbing is sought*** |
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6. Total (Rs in Cr) |
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Note: A shipment can be included only once in one of the
categories eligible for double weightage. *- Format A, ** -
Format B, *** - Format C – Kindly see these formats as per Annexure 1 below |
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7 I / We
fully understand that any statement made in this certificate, if proved
incorrect or false, will render me / us liable to face any penal action or
other consequences as may be prescribed in law or otherwise warranted.
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Place: ______________ |
Signature of CA/ ICWA /
CS:______________________ |
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Date: _______________ |
Name of the Signatory:
_____________________ |
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Address: _____________________
_________________________ |
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Membership No:
_________________________ |
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Email Address:
_________________________________ |
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If any of documents of record
mentioned in serial number (i) have not been
maintained / furnished, examined or verified, they may please be specified
below:- 1) 2) … |
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Annexure 1 to Annexure
to ANF 3A
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Format A Certificate of Exports with Double Weightage Note: A shipment is included in one of
categories indicated below only once. |
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Sl. No. |
Category of Exports |
FOB / FOR / Foreign Exchange Earned (Rs in Cr) |
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1 |
Exporters in Small Scale
Industry (SSI) / Tiny Sector / Cottage Sector |
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2 |
Units registered with KVICs /
KVIBs |
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3 |
Units located in North Eastern
States, Sikkim and Jammu & Kashmir |
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4 |
Units exporting handloom / handicrafts
/ hand knotted or silk carpets |
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5 |
Exporters exporting to
countries in Latin America / CIS / sub-Saharan Africa as listed in Appendix-9
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6 |
Units having ISO 9000 (series)
/ ISO 14000 (series) / WHOGMP / HACCP / SEI CMM level-II |
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7 |
Foreign Exchange Earned by
Supply of Services as per Format A1 below |
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8. Total FOB Value (Rs in Cr) |
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9. FOB Value of
Exports with Double Weightage (Rs in Cr) = [2 * Total FOB Value] |
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Place: ______________ |
Signature of CA/ ICWA /
CS:_______________________ |
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Date: _______________ |
Name of the Signatory:
______________________ |
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Address:
_________________________________ |
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Membership No:
___________________________ |
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Email Address:
_________________________________ |
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Format A1 Certificate of Foreign Exchange Earned by Supply of Service from
India to (outside India or In India) |
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Sl. No. |
Category of Service
Provider |
Sr. No. of Appendix 10
(within each category) |
Foreign Exchange
Earned |
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1 |
Para 9.53 (i) |
i) |
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2 |
Para 9.53 (ii) |
i) ii) |
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3 |
Para 9.53 (iii) |
i) |
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4 |
Para 9.53 (iv) |
i) |
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5. Total Foreign
Exchange Earned by Supply of Service from India (Rs in Cr) |
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Place: ______________ |
Signature of CA/ ICWA /
CS:_______________________ |
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Date: _______________ |
Name of the Signatory:
______________________ |
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Address:
_________________________________ |
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Membership No:
___________________________ |
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Email Address:
_________________________________ |
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Annexure 1 to Annexure
to ANF 3A (continued)
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Format B Certificate of FOR value of Deemed Exports |
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Sl. No. |
Category of Deemed Exports (Chapter 8 of FTP) (Please quote the relevant sub para in brackets) |
FOR |
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1 |
e.g. Supply to Advance
Authorisation (8.2 (a)) |
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2 |
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3 |
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4 |
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5 |
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6 |
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7. Total FOR Value (Rs in Cr) |
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Place: ______________ |
Signature of CA/ ICWA /
CS:_______________________ |
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Date: _______________ |
Name of the Signatory:
______________________ |
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Address:
_________________________________ |
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Membership No:
___________________________ |
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Email Address: _________________________________
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Format C Name (s) of SEZs / EOUs / EHTPs / STPs / BTPs and exports thereof, if clubbing is sought for grant of Status |
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Sl. No. |
Names of Exporting
Units |
FOB |
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1 |
SEZs |
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2 |
EOUs |
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3 |
EHTPs |
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4 |
STPs |
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5 |
BTPs |
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6. Total FOB Value (Rs in Cr) |
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Place: ______________ |
Signature of CA/ ICWA /
CS:_______________________ |
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Date: _______________ |
Name of the Signatory:
______________________ |
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Address:
_________________________________ |
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Membership No:
___________________________ |
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Email Address:
_________________________________ |
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