ANF
5A
APPLICATION FORM FOR EPCG AUTHORISATION ISSUE
{Please see guidelines
(given at the
end) before filing the application}
I. IEC
Number
2.
Applicant
Details
i. Name
ii.
Address
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3. RCMC Details
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i.
RCMC
Number
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ii.
Date
of
Issue
and
valid
upto
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iii.
Issuing Authority
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iv.
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. Merchant cum
Manufacturer
-
Exporter
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iv.
Service
Provider
-
Exporter
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v.
Others(
please
specify)
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5.
Industrial
Registration
Details
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i.
SSI
/
IEM/LOI or IL
Registration
Number
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ii.
Date
of
Issue
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iii.
Issuing Authority
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iv.
Products
for
which
registered
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Col 6 Deleted ( Ref
by Public Notice No. 109(RE-2008)/2004-09, dated 17th November, 2008)
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7.
Service
Tax Registration
Details ( In case of
Service
providers
registered
with
Service Tax
authorities)
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i.
Service
Tax
Registration
Number
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ii.
Issuing
Authority
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iii.
Services
for
which
registered
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8. Excise
Details (For
those
registered with
Central
Excise Authority
)
i.
Excise
Registration Nimber
ii.
Date
of
Issue
/
Issuing
Authority
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9. Status
House Details
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i. EH / SEH
/TH / STH /
PTH
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ii.
Certificate Number
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iii. Date of Issue and valid upto
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iv.
Issuing
Authority
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10.
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
and
branch
on
which
drawn
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86
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11. Sector
Classification
of
Capital
Goods sought
to be
imported under the
Scheme
(Please
tick)
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i.
Industrial
sector
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ii.
Agricultural
sector
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iii. Port sector
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iv.
Service
sector
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v.
Retail
sector
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vi.
Others
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11A.
whether
imports
made are also
Project
Imports as
per
Para 5.1B of
Policy
Yes
/
No
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11B.
whether
imports
made are under
Technological Upgradation
Scheme
Yes
/
No
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|
If
yes,
give
following
details:
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Sr
No
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FOB Authorisation No
|
FOB Authorisation Date
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FOB Value /
duty saved
|
FOB
fixed
in
freely
convertible
currency
|
%age of FOB
fulfilled
|
Expiry date of FOB period
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|
1
|
2
|
3
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4
|
5
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6
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7
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11C.
Details of
Freely
Importable
Capital
Goods
applied for
import
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S
No
|
Description of the
items
of
import
|
ITC(HS)
Code
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Nature of Capital
Goods
sought to
be
imported
+
|
Primary Use of Capital Goods
sought to be
imported
++
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1
|
2
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3
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4
|
5
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Technical Specifications/
Model
No.
etc
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Quantity
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CIF
Value
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6
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7
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8
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11D.
Details of
Restricted
Capital
Goods
applied
for
import
|
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S
No
|
Description of the items of
import
|
ITC(HS) Code
|
Nature of Capital Goods
sought
to be
imported
+
|
Primary Use of Capital Goods
sought to be
imported ++
|
|
1
|
2
|
3
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4
|
5
|
|
|
|
|
|
|
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Technical Specifications/ Model
No.
etc
|
Quantity
|
CIF
Value
|
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6
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7
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8
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11E.
Total
CIF value
of
CG
to
be
imported:
+ -
whether
Capital Goods /
Spares / Tools
/Jigs
/
Fixtures / Dies / Moulds
/spare
Refractories /
Catalyst/
++ - whether
used for Pre Production
activity/
Production
activity/
Post
Production activity/ For
rendering
Services
(From
amongst
col.11Cand
11D
above
please
fill up whichever
is
applicable. In case
applicant desires
to
import
both
restricted
and
freely
importable
capital
goods appropriate
information should
be
given
in
both the
cols.)
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11F.
In case the CG
proposed
to
be
imported is
under
restricted
category
following
information
with
regard
to
the
sponsoring
authority
may be
furnished ( To
be
furnished wherever
applicable)
|
|
Ministry / Department
recommending the case
|
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Recommendation letter no. and date
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11G (a). Port of
Registration for
purpose
of
imports
87
11G (b). Address
of
the
Factory/Premises
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11G (c).
Supporting
manufacturer
details
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In case the
proposed CG
sought to be
imported are
to be
used by
supporting
manufacture,
please
furnish
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|
i.
Name
of
Supporting
Manufacturer:
|
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ii.
Address
of
supporting
manufacturer
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iii. SSI /
LOI / IL Regn. No. &
Date of Supporting
Manufacturer
|
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iv.
Product
endorsed
on
SSI/IL/IEM: (of
Supporting
Manufacturer)
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v.
Excise
Reg.
No.
and
issuing
authority (if applicable) (of
supporting
manufacturer)
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12.
Details of
duty
saved
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Total
effective Custom
Duty
on items
to beimported/deemed to be
imported
(in %)
+++
|
Duty
to be
leived under
the
scheme
(in
%)
|
Duty
saved in (%)
|
CIF
value of
imports
/
deemed imports in
Rs.
|
Duty
saved in Rupees
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1
|
2
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3 = 1-2
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4
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5
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Note:
i. +++ in case
of
indigenous
sourcing of
CG
, duty
saved is
to be
calculated
on
notional
custom
duty
saved
on
FOR Value of CG
as per para
5.7A of
FTP
ii. In case
of
EPCG Authorization
for
projects
as per para
5.1B of
Policy,
the
basic customs
duty
would
be
7.5%.
wherever
CVD
is
paid in
cash
and
not
subsequently
cenveted,
CVD would
not be
taken
for computation of
net
duty
saved.
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13. Whether
any
export
obligation has
been imposed in
the
Letter of Intent/Industrial
Licence/Foreign Collaboration
approval
Yes/No
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I
.If yes, please furnish details thereof including FOB fulfilled, if any
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ii.
In
case
of
Service
Provider,
please
furnish
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a.
Serial
No
of
Appendix
36
under which
classified
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b.
Whether registered with
Service tax
authorities
Yes
/ No
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14.
Products to
be
exported/Services
to
be
rendered
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15A.
Details of
exports
made in
preceding
4
licensing years
same
and
similar
products
(including
exports against all
pending
EPCG
Authorisations)
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Sl.No.
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Financial Year
|
Amount of
Export of
same
product
/ services
|
Export
Amount for similar product
/ services
|
Export
Amount for alternate /
other
product
/ services
|
Total
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1
|
2
|
3
|
4
|
5
|
6
=3+4+5
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1.
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2.
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3.
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4.
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Total
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15B.
Export Channel Details
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Sl.No.
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Financial Year
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Direct
Exports
By applicant firm
itself
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Through Third
party
Exports
|
Through
Group company
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Total
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1
|
2
|
3
|
4
|
5
|
6
=
3+4+5
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1.
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2.
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3.
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4.
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Total (1+2+3+4)
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88
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15C.
Details
of
Group Company
Exports
1. Group company
Name
2. Date of Incorporation
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Sl.No.
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Financial Year
|
Product
Particulars
|
Direct
Exports
Value
|
Value of
Group
Company
Exports
through
third
party
|
Total
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|
1
|
2
|
3
|
4
|
5
|
6
=
4+5
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1.
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2.
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3.
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4.
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Total
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16. EPCG Authorisations
already obtained
till date.
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S. No
|
EPCG
Authorisation No and
Date
|
Products to
be exported/services
to be
rendered
|
RA which issued
Authorisation
|
CIF
Value
/
Duty
saved (Rs)
|
Expiry Date
of
E.O. Period
|
Redemptio n Date / Remarks
|
|
1
|
2
|
3
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4
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5
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6
|
7
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(i)
|
Redeemed
cases
during the
last 4
years
(year-wise)
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Total:
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(ii)
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Not
redeemed cases
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Total:
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16
(Contd.)
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Sl. No.
|
EPCG
Authorization
Details &
Date
|
Average
EO
(over
complete EOP)
|
Specific EO on CIF
/
Duty
Saving
(over
complete EOP)
|
Total EO
|
|
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|
Fixed
|
Fulfilled
|
Fixed
|
Fulfilled
|
Fixed
|
Fulfilled
|
|
1
|
2 (as in 16)
|
8
|
9
|
10
|
11
|
12 = 8+10
|
13 = 9+11
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(i)
|
Redeemed
EPCG Authorization
|
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Total (i)
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(ii)
|
Non-Redeemed
EPCG
Authorization
|
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Total (ii)
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Grand Total (i +
ii)
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17A.
Details of Export
Obligation (Average
and
Specific):
|
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Average
Export Obligation
to be
imposed
(Rs) (as
shown in sr.no.15(A)
[Total of Col
(3+4) of
row
(2+3+4)/3]
|
Total
duty saved (Rs.) as
per
column
no.5 at
sr.no.12.
|
Specific Export Obligation to be
imposed
(as
a multiple of
duty
saved)
|
Total
Export Obligation
imposed
|
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|
(Rs.)
|
(USD)
|
(Rs.)
|
(USD)
|
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|
Rs.
|
USD
|
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|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
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17B.
Export obligation
Period: (8 year/
12 years) :
Note:
For
Premier
Trading
Houses,
exercising
option
of average over
5
years,
all
the
above
details
must
be
given
for
2
more
years.
89
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
and
if
found incorrect
or
false 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
the
Foreign Trade
(Development and Regulation)
Act,
1992,
the
Rules and
Orders
framed there under, the Foreign
Trade Policy, the Handbook of Procedures
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 neither the
Registered
Office/Head
Office of the firm/company
nor
any
of its Branch
Office(s)
/ Unit(s) / Division(s)
has been
declared
a defaulter
and has otherwise
been made
ineligible
for undertaking
import /
export
under
any of the provisions of the
Policy.
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
Handbook of Procedures
(Vol.1),
irrespective
of
the
scheme
under which the item is exported /
proposed
to
be
exported.
6.
I /
We
declare that
no export
proceeds are
outstanding
beyond
the
prescribed
period as
laid
down by the
RBI, or
such extended period for
which
RBI
permission has
been obtained.
7.
I /
We
hereby declare that
the capital
goods/spares sought
for
import in
the application are
actually required
for
use at pre
production/production/post
production
stages for
the
export product(s)
or for
rendering
services for
fulfilment of
export obligation.
8.
I /
We
hereby
declare that
in respect of
goods for
which
nexus is
not established
at
a later date,
I / We
shall pay to
the Government Customs duty saved together
with
15% interest on such imported goods
which
are found having no relation
with
product
exported or service rendered.
9.
I /
We
hereby
declare
that
in case
of
import
of refurbished/reconditioned spares,
the
refurbished/reconditioned spares have
a
residual
life which is not less than 80%
of
the
life
of
the
original
spares.
10.
I
/
We hereby
declare that
I
/
We do
not
come under
the purview of
Service
Tax and
therefore
are
not registered
with the
Service
Tax
Cell of
the
jurisdictional
Central
Excise Authorities. (in
case
of
Service Providers
who
are
not covered under service tax)
11.
I
/
We hereby
declare that
I/We
shall
not exceed
the SSI
investment limit
in
plant and
machinery after making
imports under the
EPCG Authorisation.
(applicable in
cases of imports made by
SSI
sector)
12.
I
/
We
hereby declare that
the
import of
capital
goods shall
be
used for
building
and
operating shopping
malls/super markets having a minimum
covered
area
of
1000
sq
meters. (Applicable in case of imports made by
Retail
sector).
13.
I
/ We hereby declare that I/We
have not made imports under the Technological
Upgradation Scheme previously
before
any
Licensing
authority
and
the present
imports of
Capital
Goods to
be
made
under
this
Scheme
(for which this
application is
made) are
more than 10%
of the
my/our
present investment
in the plant
and
machinery. (applicable
in
case
of
imports
under
EPCG Technological Upgradation
Scheme)
13(a)
Self certified copy of IEM/SSI registration number in case of products and a self-certified
copy of Service Tax Registration
in case of Service Providers.
(In case of Service Providers, who are not registered
with Service Tax Authorities and a declaration in this regard has
been
submitted as a part of the application (Declaration
No.10), Service Tax Registration is not required to be submitted.
In such cases, RCMC from EPC concerned will suffice).
I/We undertake to submit a self certified copy of
‘Drug Manufacturing Licence’ in case of export of Pharmaceutical
Product(s) within a period of three years from the
date of issue of EPCG Authorization failing which the Bank Guarantee
/Legal Undertaking executed/furnished at the time
of clearance of Capital Goods with Customs authorities/Regional
Authorities of DGFT, as the case may be, is liable
to be forfeited/invoked and I/We would be liable to pay Customs Duty
saved amount together with applicable interest thereon
from the date of first import till the date of final payment. (Ref.
DGFT Public Notice No. 109(RE-2008)/2004-09,
dated 17th November, 2008)
14.
I
hereby
certify that
I
am
authorised to
verify and
sign this declaration as per
Paragraph
9.9
of
the
Policy.
(Note:
Strike out the
clause
which is not
applicable.)
Signature of the Applicant
Place
Name
Date
Designation
Official Address
Telephone Residential Address
Email
Address