ANF 4 G DEPB application [Please see guidelines (given at the end) before filling the application] 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 Products for which registered 4. Type of Exporter (please tick) ( ? ) i. Merchant Exporter ii. Manufacturer Exporter iii. Service Provider iv. Others (please specify) v. Merchant cum Manufacturer 5. Application Fee Details Amount (Rs) Demand Draft / Bank Receipt / Electronic Fund Transfer No Date of Issue Name of the Bank on which drawn Bank Branch on which drawn 6 FOB Value of exports (inclusive of commission) i. In Rupees ii. In freely convertible currency 7. DEPB Claimed i. In Rupees (in words) ii. In Rupees (in figures) 8. Port of Registration (for the purpose of imports): 70 9. Details of export made S No. SB* / PPR** No. SB* / PPR** Date Date of Let Export BRC No. BRC Date In- voice No. S.No. of In- voice Pro- duct Group DEPB Sr. No. Item Des Crip- tion FOB Value in free foreign exchange (inclusive of commission) Ex- change rate on the date of let export FOB value (in Rs.) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) = (12)x (13) * SB - Shipping Bill ** PPR - Post Parcel Receipt Computation of Capped Value DEPB rate DEPB entitlement (without cut) Cut applicable (if any) Actual DEPB Entitlement Unit of Measurement in the unit of value cap Export Qty in U/M Value Cap FOB per U / M Capped Value (in %) (in Rs) (in %) (in Rs) (15) (16) (17) (18)= (14) / (16) (19) = { minimum of (17) and (18)} or (18) as the case may be (20) (21) = (16) * (19) * (20) / 100 (22) (23) = (21) * { 1 - [(22)/100]} Note: In case there is no value cap on the product, the capped value would be equal to the FOB value per unit of measurement (U/M) as at Column (18) of the table above. Else it would be the minimum of Columns (17) and (18) 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. 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. 71 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(s) Residential Address Email Address 72 GUIDELINES FOR APPLICANTS [Please see paragraph 4.43 of HBP v1] 1. Two copies of the application must be submitted unless otherwise mentioned. In case application is filed through digital signature, no hard copy is required. 2. Each individual page of the application has to be signed by the applicant. 3. RCMC details need not be given if the same has already given at the time obtaining IEC. 4. Application must be accompanied by documents as per details given below: a. Bank Receipt (in duplicate) / Demand Draft/EFT details evidencing payment of application fee in terms of Appendix 21B. b. Export Promotion (EP) copy of Shipping Bill(s). In case of exports to SEZ Units/ Developer/Co-developer of SEZ, Bill of Export may be accepted in lieu of Shipping Bill. c. Bank Certificate of Exports and Realisation as given in Appendix 22A or Foreign Inward Remittance Certificate (FIRC) in the case of direct negotiation of documents or Appendix 22 D in the case of offsetting of export proceeds with the approval of RBI. In case of FIRC, a declaration from the exporter that the remittance is in respect of Shipping Bill(s) No ____________ dated _________ shall also be furnished. However, realisation of export proceeds shall not be insisted if the shipments are made against confirmed irrevocable letter of credit or bill of exchange is unconditionally Avalised / Co- Accepted/ Guaranteed by a bank and the same is confirmed by the exporters bank and certified by the bank in column 14/15 of Appendix 22A. For status holders, irrevocable letter of credit would suffice. 73
