Aayaat Niryaat Form - Served from India Scheme (SFIS)

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

v.  Products for which registered

4. Category of Service Provider (please tick)

                                                                                                                                                ( √ )

i. Individual Service Provider

ii. Hotels & Restaurants and other service Providers in Tourism Sector except Stand-alone restaurant.

iii. Stand Alone Restaurant

iv. All other Service Providers

5. Foreign Exchange Earned for rendering of Service from India to (outside India or In India)

Sr. No.

Supply of Service by Service Provider

Foreign Exchange Earned (Rs)

1

Supply of a ‘service’ from India to any other country under Para 9.53 (i) of FTP.

2

Supply of a ‘service’ from India to service consumer of any other country in India under Para 9.53 (ii) of FTP.

3

Supply of a ‘service’ from India through commercial or physical presence in territory of any other country under Para 9.53 (iii) of FTP.

4

Supply of a ‘service’ in India relating to exports paid in free foreign exchange or in Indian Rupees which are otherwise considered as having being paid for in free foreign exchange by RBI under Para 9.53 (iv) of FTP by Hotels & Restaurants and other service Providers in Tourism Sector except Stand-alone restaurant.

5

Supply of a ‘service’ in India relating to exports paid in free foreign exchange or in Indian Rupees which are otherwise considered as having being paid for in free foreign exchange by RBI under Para 9.53 (iv) of FTP by categories 4(i), 4(iii), and 4(iv) above.

Total (Rs)

Entitlement of SFIS (Rs) = [(5%*Row 4) +10%* (Total – Row 4)]

8. Application Submission Details (in case of electronically submitted applications)

9. Application Fee Details

i.    ECOM Reference Number

(i)     Amount (Rs):

ii.   Date of Submission on Server

(ii)    Demand Draft / Bank Receipt / Electronic Fund Transfer No

iii.  Submitted to which Regional Authority

(iii)   Date of Issue

iv.  File Number

(iv)   Name of the Bank on which drawn

v.   Date of Issue

(v)    Bank Branch on which drawn

Place: ____________

Signature: ________________________________

Date: _____________

Name: ___________________________________

Documents to be submitted

Designation: ______________________________

1.     Documentary evidence for payment of Application Fee

Official Address: ___________________________

_________________________________________

2.     CA / ICWA / CS certificate in format given in annexure to ANF 3B.

Telephone: _______________________________

Residential Address: ________________________

_________________________________________

Note: Each page of application has to be signed.

Email Address: ____________________________

(i)

Following documents / records have been furnished by applicant individual / firm / company and have been examined and verified by me / us namely: -

Forward Inward Remittance Certificates (FIRCs), Bank Realization Certificates, Certificate from international credit card companies, and evidences of foreign exchange earnings as well as the connected books of accounts.

(ii)

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)

Information given by applicant in ANF 3B including details on Services rendered From India as per Appendix 10 of HBP v1 (with relevant sr. no. and description) is true and correct.

(iv)

Services for which benefits is claimed does not include ineligible services and remittances as listed under Para 3.18.1 of HBP v1.

(v)

It has been ensured that 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;

(vi)

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;

Place: ______________

Signature of CA/ ICWA / CS:_______________________

Date: _______________

Name of the Signatory: ______________________

Address: _________________________________

_________________________________________

Membership No: ___________________________

Email Address: _________________________________

(vii)

Certificate of Foreign Exchange Earned by Supply of Service from India to (outside India or In India) is as under:

            Certificate of Foreign Exchange Earned by Supply of Service from India to

(outside India or In India)

Sr. No.

Category of Service Provider

Sr. No. of Appendix 10

(within each category)

Foreign Exchange Earned

(Rs)

1

Para 9.53 (i)

i)

…

2

Para 9.53 (ii)

i)

ii)

iii)

…

3

Para 9.53 (iii)

i)

ii)

…

4

Para 9.53 (iv)* for Category 4(ii) of Sr. No 5 of ANF 3B

i)

ii)

iii)

….

5

Para 9.53 (iv)* for Category 4(i), 4(iii), 4(iv) of Sr. No 5 of ANF 3B

i)

ii)

Total Foreign Exchange Earned by Supply of Service from India to (outside India or In India)  (Rs)

*Includes payments received in Indian Rupees that are otherwise treated as deemed to be realized in free foreign exchange – See Para 9.53 (iv).

(vii)

I fully understand that any statement made in this certificate, if proved incorrect or false, will render me liable to face any penal action or other consequences as may be prescribed in law or otherwise warranted.

Place: ______________

Signature of CA/ ICWA / CS:_______________________

Date: _______________

Name of the Signatory: ______________________

Address: _________________________________

_________________________________________

Membership No: ___________________________

Email Address: _________________________________