ANF 4D For clubbing of Advance Authorisations [ Please see guidelines (given at the end) before filling the application ] 1. IEC Number 2. Applicant Details i. Name ii. Address 3. Details of Authorisations to be clubbed S No Authorisation No Authorisation date Customs Notification no Export product Port of Registration 1 2 3 4 5 6 CIF value permitted (in Rs) CIF value used (in FFE) EO imposed (FFE) Exports made (FFE) Expiry date of initial EO period Expiry date of extended EO period 7 8 9 10 11 12 4. Details of physical exports / deemed exports made against each individual Advance Authorisation Shipping Bill/ Invoice/ AR 3 Details Quantity Exported / Supplied FOB Value S No Products Exported/ Supplied No Date Direct exports Third Party exports Deemed Exports Total In case of physical exports (as per S/B) In case of deemed exports (as per invoices) Actually realized (as per BRC) 5. Details of imports allowed and made against each individual Authorisation S No Item of Import Qty allowed in the CIF Value allowed in Bill of Entry Details Quantity imported CIF Value used 59 Authorisation the Authorisation ( in FFE) No Date (in FFE) 6. Consolidated Details of physical exports / deemed exports made against all Authorisations Shipping Bill/ Invoice / AR 3 Details Quantity Exported / Supplied FOB Value S No Products Exported / Supplied No Date Direct exports Third Party exports Deemed Exports Total In case of physical exports (as per S/B) In case of deemed exports (as per invoices) Actually realized (as per BRC) 7. Consolidated Details of imports allowed and made against all Authorisations Bill of Entry Details S No Item of Import Qty allowed in the Authorisation CIF Value allowed in the Authorisation ( in FFE) No Date Quantity imported CIF Value (in FFE) 8. Details of excess imports made proportionate to the export obligation fulfilled Bill of Entry Details Duty Details S No Item of Import No Date Quantity Customs Duty Interest Total 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. 60 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 Residential Address Email Address 61 GUIDELINES FOR APPLICANTS [ Pl see paragraph 4.20 of HBP v1 ] 1. Two copies of the application must be submitted unless otherwise mentioned. 2. Each individual page of the application has to be signed by the applicant. 3. Clubbing of Advance Authorisation with Advance Authorisation for annual requirement not permitted. 4. Application must be accompanied by Advance Authorisation (s) in original. 62
