1.

Applicant Details

i.  Name:

ii. Address:

(Registered Office Address is required in case of Companies. Head Office Address is required for all other categories)

 Flat/Plot/Block No.:

Street/Area/Locality:

City:

State:

PIN Code

iii. For endorsing Addresses of Branches,  Divisions,  Units, Factories located in India & abroad, please attach extra sheet if require. However, please use the same address format as specified above]

iv. Telephone / Fax Nos.

Area Code along with Telephone/Fax No.

Landline (1):

Landline (2)*:

Fax No.*:

v.   Email ID / Website Address:   

Email ID: For correspondence with DGFT

Alternate Email ID:*

Website Address:* (if any)

vi. Full Name, Designation and Mobile Number of the Signatory (Signatory’s photograph is to be affixed on the Bank Certificate).

First Name

Middle Name

Last Name

Designation:

Mobile Number:

Note 1: When the name of an individual is required to be filled up, full name (in the order - First name, Middle name and Surname should be filled up as far as possible, without using any abbreviations.

For example, please fill up the full name  - ANIL KUMAR SINGH (instead of abbreviated forms like ANIL K SINGH; ANIL SINGH; A.K.SINGH; A KUMARSINGH; A.KUMAR SINGH; ANILSINGH; ANILKUMAR SINGH etc.)

This note applies to the entire ANF, particularly to Sr. No. 2 so that wherever the name / father’s name are required to be filled up, they are filled up correctly.

6.

PAN Details:

i.  PAN Number:

(Alphanumeric Field – Size 10)

ii. PAN Issuing Authority:

iii.            Name as appearing on the PAN Card:

iv.            Date as mentioned on PAN Card:

Date of Birth for Individuals

Date of Incorporation for all other categories (Trusts/ HUFs / Firms / LLPs / Companies etc.)

v.  Father’s Name in case of PAN allotted to Individuals

1.

Applicant Details

i.  Name:

Directorate General of Foreign Trade

ii. Address:

(Registered Office Address is required in case of Companies. Head Office Address is required for all other categories)

 Flat/Plot/Block No.:

Udyog Bhawan, H-Wing, Gate No. 2,

Street/Area/Locality:

Maulana Azad Road

City:

New Delhi

State:

 Delhi

PIN Code

1

1

0

0

1

1

iii. For endorsing Addresses of Branches,  Divisions,  Units, Factories located in India & abroad, please attach extra sheet if require. However, please use the same address format as specified above]

iv. Telephone / Fax Nos.

Area Code along with Telephone/Fax No.

Landline (1):

0

1

1

2

2

2

2

1

2

3

4

Landline (2)*:

Fax No.*:

0

1

1

2

2

2

2

5

6

7

8

v.   Email ID / Website Address:   

Email ID: For correspondence with DGFT

Alternate Email ID:*

dgft@nic.in

Website Address:* (if any)

http://dgft.gov.in

vi. Name, Designation and Mobile Number of the Signatory (Signatory’s photograph is to be affixed on the Bank Certificate).

First Name

Middle Name

Last Name

Prabhu

Arun

Sinha

Designation:

Company Secretary

Mobile Number:

0

8

7

2

7

9

9

1

2

3

4

Note 1: When the name of an individual is required to be filled up, full name (in the order - First name, Middle name and Surname should be filled up as far as possible, without using any abbreviations.

For example, please fill up the full name  - ANIL KUMAR SINGH (instead of abbreviated forms like ANIL K SINGH; ANIL SINGH; A.K.SINGH; A KUMARSINGH; A.KUMAR SINGH; ANILSINGH; ANILKUMAR SINGH etc.)

This note applies to the entire ANF and to Sr. No. 2 so that wherein names / father’s name are required to be filled up, they are filled up correctly.