ANF 4 G
DEPB
application
[Please see guidelines (given
at the end) before filling the application]
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2. Applicant Details
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i. Name
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ii. Address
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3. RCMC Details
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i. RCMC Number
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ii. Date of Issue
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iii. Issuing Authority
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iv. valid upto
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Products for which registered
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4. Type of Exporter (please tick)
( √ )
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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. Application Fee Details
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Amount (Rs)
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Demand Draft / Bank Receipt
/ Electronic Fund Transfer No
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Date of Issue
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Name of the Bank on which drawn
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Bank Branch on which drawn
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6
FOB Value of exports (inclusive of commission)
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i. In Rupees
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ii. In freely convertible currency
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7. DEPB Claimed
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i. In Rupees (in words)
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ii. In Rupees (in figures)
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8. Port of Registration (for the purpose of imports):
9. Details of export made
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S
No.
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SB* /
PPR** No.
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SB* / PPR**
Date
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Date
of
Let
Export
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BRC No.
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BRC Date
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In-
voice No.
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S.No. of In-
voice
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Pro-
duct Group
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DEPB Sr. No.
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Item Des
Crip-
tion
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FOB Value in free foreign
exchange (inclusive of
commission)
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Ex-
change rate on the date of let export
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FOB
value
(in Rs.)
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(1)
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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)
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(8)
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(9)
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(10)
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(11)
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(12)
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(13)
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(14) = (12)x (13)
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*
SB – Shipping Bill
** PPR – Post Parcel Receipt
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Computation of Capped Value
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DEPB rate
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DEPB entitlement (without cut)
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Cut applicable
(if any)
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Actual DEPB Entitlement
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Unit of Measurement in the unit of value cap
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Export Qty in U/M
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Value Cap
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FOB per
U / M
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Capped Value
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(in %)
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(in Rs)
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(in %)
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(in Rs)
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(15)
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(16)
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(17)
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(18)= (14) / (16)
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(19)
=
{ minimum of (17) and (18)} or (18) as the case may be
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(20)
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(21) = (16) * (19)
* (20) / 100
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(22)
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(23) = (21) *
{ 1 – [(22)/100]}
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Note: In case
there is no value cap on the product, the capped value would be equal to the FOB
value per unit of measurement (U/M) as at Column
(18) of the table above. Else it
would be the minimum of Columns (17) and (18)
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(s)
Residential Address
Email Address