ANF 4 I
Gem Rep Application
[Please see guidelines (given at the end)
before filling the application]
[ANF 4 I amended by 30-PN(RE)/20.06.2008]
1. IEC Number |
2. Applicant Details |
i. Name |
ii. Address |
3. RCMC Details |
i. RCMC Number |
ii. Date of Issue |
iii. Issuing Authority |
iv. valid upto
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Products for which registered |
4. Type of Exporter
(please tick) |
( √ ) |
i. Merchant Exporter |
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ii. Manufacturer Exporter |
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iii. Service Provider |
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iv. Others (please specify) |
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v. Merchant cum Manufacturer |
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5. Industrial
Registration Details |
i. SSI / IEM / LOI or IL
Registration Number |
ii. Date of Issue |
iii. Issuing Authority |
iv. Products for which
registered |
6. Excise Details (For
those registered with Central Excise Authority) |
i. Excise Registration Number |
ii. Issuing Authority |
7. Application Fee
Details |
Amount (Rs) |
Demand Draft / Bank Receipt /
Electronic Fund Transfer No |
Date of Issue |
Name of the Bank on which
drawn |
Bank Branch on which drawn |
8. Export Proceeds Realisation Month: |
9. FOB Value of
Exports |
i. In free foreign exchange |
ii. In Rupees |
10. Value of Authorisation Claimed |
i. In free foreign exchange |
ii. In Rupees |
11. Details of exports
made |
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Name of the Bank |
Shipping Bill/ Postal Receipt |
FOB Value |
FOB Value realised
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REP Authorisation
Claimed ( Rs ) |
Country of Exports |
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Number |
Date |
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Note: In case application for REP Authorisation is made under Para 4A.28 of this handbook,
serial no 11 may be left blank
Declaration /
Undertaking
1. I/We hereby declare that the
particulars and the statements made in this application are true and correct to
the best of my / our knowledge and belief and nothing has been concealed or
held there from. If found incorrect or false, it will render me / us liable for
any penal action or other consequences as may be prescribed in law or otherwise
warranted.
2. I/We undertake to abide by the
provisions of FT(D&R) Act, the Rules and Orders
framed there under, the FTP, HBP v1, HBP v2 and the ITC(HS) Classification of
Export & Import Items.
3. I / We hereby certify that none
of the Proprietor / Partner(s) / Director(s) / Karta / Trustee of the firm /
company, as the case may be, is / are a Proprietor / Partner(s) / Director(s) /
Karta / Trustee in any other firm / Company which has come to the adverse
notice of DGFT.
4. I/We hereby certify that the
Proprietor / Partner(s) / Director(s) / Karta / Trustee, as the case may be, of
the firm/company is / are not associated as Proprietor / Partner(s) /
Director(s) / Karta / Trustee in any other firm/company which is in the caution
list of RBI.
5. I / We hereby declare that I /
we have perused the list of SCOMET items as contained in the Appendix 3 to the
Schedule 2 of the ITC (HS) Classifications of Export-Import Items, 2004-09 and
that the item(s) exported / proposed to be exported does not fall within this
list and that I / We agree to abide by the provisions of the Policy for export
of SCOMET items contained in the Foreign Trade Policy, Schedule 2 of ITC (HS)
and the HBP v1, irrespective of the scheme under which the item is exported / proposed
to be exported (the underlined portion will be deleted in case an application
for export license for SCOMET item is being filed).
6. I / We hereby declare that no
export proceeds are outstanding beyond the prescribed period as laid down by
RBI or such extended period for which RBI permission has been obtained.
7. I hereby certify that I am
authorised to verify and sign this declaration as per Paragraph 9.9 of the FTP.
Signature of the Applicant Place
Name Date
Designation
Official Address
Telephone
Residential Address
Email Address
Guidelines for Applicants
[Please see paragraph 4 A.1 and 4A.28 of HBP
v1]
1. Two copies of the application
must be submitted unless otherwise mentioned.
2. Each individual page of the
application has to be signed by the applicant.
3. RCMC details need not be given
if the same has already given at the time obtaining IEC.
4. Application must be accompanied
by documents as per details given below:
a. Bank
Receipt (in duplicate)/Demand Draft evidencing payment of application fee in
terms of Appendix 21B.
b. Bank
certificate of export and realisation in the format
given in Appendix 22A evidencing realisation of
exports proceeds/sales proceeds.
c. Export
Promotion (EP) copy of Shipping Bill(s) in Original. (Photocopy of the EP copy
of Shipping Bill duly endorsed may be returned for utilization/re-import
purposes when the exports are made on consignment basis).
d. Customs
attested invoice.
e. In case of
application for Replenishment Authorisation under
paragraph 4A.28 of this Handbook, an applicant will be required to submit
documents as given at S.No.1 above and Statement of Exports made during the
preceding licensing year duly certified by Chartered Accountant / Cost &
Works Accountant in the format given in Annexure to ANF 4 I below.
Annexure to ANF 4 I
Certificate of
Chartered Accountant Cost and Works Accountant
I/We hereby confirm that I/We have examined the prescribed registers and
also the relevant records of M/s..........................
having
IEC number
... and PAN number
.for the licensing period(s)
and hereby certify that:
(i)
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The following documents/ records have been furnished by the applicant
firm/company and have been examined and verified by me/us namely: - a.
Statutory documentation
under the 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, Bank Certificates of exports made in their
own name, GR declaration etc and connected books of accounts; |
(ii)
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The relevant accounting and financial register(s) as prescribed under
different Acts and Rules made there under have been maintained and
authenticated under my/our seal and signature. |
(iii)
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The information given by the applicant firm/company in the Aayaat Niryaat Form including
details on a.
imports/exports made, b.
foreign exchange
earnings/ realization (both from direct and indirect sources) is in agreement with the Foreign Trade Policy 2004-09 and the rules and
procedures made there under, the relevant register and records and the books
of accounts maintained by M/s...........
... and their subsidiaries and
is also true and correct. |
(iv)
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It has been ensured that the 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; |
(v)
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Neither I, nor any of my/our partners is a partner, director, or an employee
of the above-named entity, its Group companies or its associated concerns; |
(vi)
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(vii) |
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. |
S.No |
Shipping Bills Nos |
Date of Let Export |
Description of product |
FOB value (in rupees) |
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(Signature and Stamp/
Seal of the Signatory)
(Chartered Accountant/
Cost & Works Accountant)
Name of the Signatory:
Place: Address:
Date: Membership
No:
If any of the documents of record mentioned in serial number (i) have not been maintained/ furnished, examined or
verified, they may please be specified below:-
1.
2.
Note: Each page of this annexure is to be signed by the
Chartered Accountant / Cost & Works
Accountant with his registration number.