ANF 3A
Application for Grant of Status Certificate
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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
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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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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/CA in annexure attached.
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Sr. No.
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Year
(Please specify the year)
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Exports (Rs in Cr)
As in Row 6 of Sr. 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
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Current Year (say e.g. 2007-08)
[Please specify period (say Apr - Sept 2007) for which
exports are taken into account in this row]
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2
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Previous Year 1
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3
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Previous Year 2
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4
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Previous Year 3
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5. Total
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Note: 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.
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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.
Consequentially, I further declare that under Foreign Trade (Development and Regulation)
Act (FT (D&R) 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 FT (D&R) 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.
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 FT (D&R) Act, 1992, Rules and Orders framed there
under, 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: ____________
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Signature:
________________________________
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Date: _____________
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Name: ___________________________________
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Documents to
be submitted
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Designation: ______________________________
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1.
One Printout of Online application
duly signed in provided space.
2.
Copy of Updated Profile in
ANF 1only if any changes have taken place and updated.
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Official Address: ___________________________
_________________________________________
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3.
Self certified copy of valid
RCMC.
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Telephone: _______________________________
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4.
CAC as per Annexure attached
5.
Copy of earlier Status Certificate,
if any.
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Residential Address: ________________________
_________________________________________
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Email Address: ____________________________
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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:
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1
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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.
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2
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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.
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3
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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.
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4
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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: ______________
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Signature
of CA/ ICWA / CS:_______________________
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Date: _______________
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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)
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5
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I / We further certify that export proceeds for shipments during last three years
plus current are not outstanding beyond prescribed period as permitted by RBI.
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6
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Statement of Exports
/ Deemed Exports /
Foreign Exchange Earned by Supply of Service is as under:
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Statement of Exports / Deemed Exports / Foreign Exchange
Earned by Supply of Service from India
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Type of Exports (Rs in Cr)
(FOB / FOR value / Foreign Exchange Earned)
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Current Year
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Previous Year 1
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Previous Year 2
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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)
(Row 9 in Format A below)
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3. FOR value for Deemed Exports
(Chapter 8 of FTP)**
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4. Exports of Subsidiary Company
(Please specify the name and give the proof thereof)
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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
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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: ______________
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Signature
of CA/ ICWA / CS:_______________________
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Date: _______________
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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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Sr. No.
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Category of Exports
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FOB / FOR / Foreign Exchange Earned
(Rs in Cr)
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1
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Exporters in Small Scale Industry (SSI) / Tiny Sector / Cottage Sector
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2
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Units registered with KVICs / KVIBs
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3
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Units located in North Eastern States, Sikkim and Jammu & Kashmir
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4
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Units exporting handloom / handicrafts / hand knotted or silk carpets
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5
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Exporters exporting to countries in Latin America / CIS / sub-Saharan Africa as
listed in Appendix-9
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6
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Units having ISO 9000 (series) / ISO 14000 (series) / WHOGMP / HACCP / SEI CMM level-II
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7
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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: ______________
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Signature
of CA/ ICWA / CS:_______________________
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Date: _______________
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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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Sr. No.
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Category of Service Provider
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Sr. No. of Appendix 10 (within each category)
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Foreign Exchange Earned
(Rs in Cr)
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1
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Para 9.53 (i)
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i)
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2
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Para 9.53 (ii)
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i)
ii)
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3
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Para 9.53 (iii)
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i)
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4
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Para 9.53 (iv)
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i)
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5. Total Foreign
Exchange Earned by Supply of Service from India
(Rs in Cr)
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Place: ______________
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Signature
of CA/ ICWA / CS:_______________________
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Date: _______________
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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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Sr. No.
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Category of Deemed Exports (Chapter 8 of FTP)
(Please quote the relevant sub para in brackets)
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FOR
(Rs in Cr)
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1
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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: ______________
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Signature
of CA/ ICWA / CS:_______________________
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Date: _______________
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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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Sr. No.
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Names of Exporting Units
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FOB
(Rs in Cr)
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1
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SEZs
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2
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EOUs
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3
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EHTPs
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4
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STPs
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5
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BTPs
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6. Total FOB Value (Rs in Cr)
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Place: ______________
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Signature
of CA/ ICWA / CS:_______________________
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Date: _______________
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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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