APPENDIX-15A

APPENDIX-15A

APPLICATION FORM FOR GRANT OF EXPORT LICENCE FOR EXPORT OF SPECIAL CHEMICALS, ORGANISMS, MATERIALS, EQUIPMENTS AND TECHNOLOGIES (SCOMET) ITEMS MENTIONED AS RESTRICTED FOR EXPORT IN APPENDIX-3 SCHEDULE 2 OF ITC(HS) CLASSIFICATIONS OF EXPORT AND IMPORTS ITEMS

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Note:

1. Please read the general instructions given at Appendix 1 before filling this application.

2. Please submit 5 copies of this application form.

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FOR OFFICIAL USE

File No.:-------------------------------- Date:-----------------------

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PART-I

    1.    Name and address of the Applicant 	:

    2.    IEC Number                        		:


PART-II

(To be filled in for export of Special Chemicals in Categories 1B and 1C of Appendix-3)

    3.    (i)   Item of export			:

          (ii)  Quantity applied for		:

          (iii) FOB value per unit		:

          (iv)  Total FOB Value			:

    4.    Details  of  the  exports of   category 1B and 1C  Items in 
          preceding three licensing years



S.No
Year
Name of the item
Licence no. and date
Qty & value in US$  of the licence
Qty & value in US$  of the item exported
Name of the end user
	Country to which exported
[1]
[2]
[3]
[4]
[5]
[6]
[7]
	[8]
 
 
 
 
 
 
 
 



    5.    If  applied for export on  		:
          repeat basis in the same
          licensing year for same
          product and end-use and to
          the same end-user, then
          following information may
          also be furnished

          (i)   Reference  number   and  		:
                date  vide   which  the
                earlier permission  was  
                granted by this office

          (ii)  Export  licence  number  		:
                and date

          (iii) Quantity  allowed   for  		:
                export

          (iv)  Quantity  exported   on  		:
                the   date    of   this
                application

    6.    Export   Order  No.  &  date   		:
          (Attach copy)

    7.    Name  and full address of the  	:
          buyer

    8.    Name  and full address of the  	:
          end user

    9.    Port of shipment               		:

   10.    Destination of export

          (i) Port of Discharge          		:

          (ii) Ultimate Destination      		:

   11.    End  product  for  which  the  	:
          item  of export will be  used
          by the end  user (attach  end
          user certificate)

    12.   The purpose for which the end  	:
          product will be utilised

    13.   If  application is for export  		:
          of   samples,   furnish   the
          following details:

          (i)   Ceiling limit            		:

          (ii)  How  much in excess  of  		:
                the ceiling limit

          (iii) Justification for excess 		:


PART-III
(To be filled in for export of all  other Category items of Appendix-3 except those covered by Part-II 
above)

    14.	Category, item  number  and item 	:
	name  as in Schedule 2 Appendix 3 
	of ITC (HS) Classifications of Export 
	And Import items (Attach technical 
	specification  not  exceeding  one 
	page for item, in the order in which 
	these items   have   been listed)	

    15.    (i)  Quantity  applied for     		:

            (ii) FOB value per unit (US $) 	:       

           (iii) Total FOB value (US $)    		:       

    16.   Importer"s  Purchase Order  number 	:
           and date (Attach copy)

    17.  Is the applicant the producer/ 	:
          manufacturer of the item to  be 
          exported?  If not, name the producer/ 
          manufacturer and provide full address, 
          telephone No. etc.

   18.   Details of Export Licences (EL) previously :
          applied for items under Schedule 2 
          Appendix 3 of ITC(HS) (HS)Classifications
          of Export and Import items	



S.No.
Date of application
No. & date of export licence (see Note below)
Items exported & Qty-Value
Date of shipment (attached B/L copy)
Destination Country
[1]
[2]
[3]
[4]
[5]
[6]
 
 
 
 
 
 

					

* State  "denied",  if the licence was denied.  A false statement will invite prosecution.

   19.  Port of Shipment                        	:
         (Delhi, Mumbai, Calcutta or Chennai -
         Identify only one Port)

   20.  Destination of Export (Country)         	:

   21.  Name  of  the   consignee,  complete    	:
         postal address;  telephone, fax etc.

   22.  Citizenship   of     consignee   (if   	:
         individual)

   23. Headquarters  address of  consignee,     	:
        if  corporate  office  different from
        entry at (10) above.

  24.  (a)  Location (country) of end-user   	:

        (b)  End product and/or end- purpose    	:
              for  which  the exported  item will 
	 be  used by  the  end  user. (Attach
              end-use certificate in the
              prescribed proforma)

        (c)  Name and complete address of     	:
              end-user (include telephone,
              fax Nos.  etc.)

        (d)  Is  end-user  an  entity  of     	:
              Government  of   destination
              country?

        (e)  Manufacturing/Business/Other     	:
              activity of the end user.

  25.  Through  which  banks    will   the
        financial  transactions relating  to
        this export be executed?

       (a)	In destination country		:
	(provide full address)

       (b)	In India				:

  26.  Name and address of all foreign 		:
        Collaborators of the applicant 
        (as registered with GOI/RBI).  
        If none, state None.

  27.  Period during which the item is		: 
        proposed to be exported from India.

  28.  If revalidation required 		:

        (a) Period of extension sought		:
        (b) Reasons therefor  

DECLARATION/ UNDERTAKING

I/We solemnly declare/undertake that:-

(i) The particulars and the statements made in this application and attachments thereto are true to the best of my/our knowledge and belief, and nothing has been concealed or withheld therefrom.

(ii) If any information furnished in this application is found to be false, inaccurate, not current or misleading, any licence granted on the basis of this application shall be liable to cancellation or being made ineffective without prejudice to any other action that may be taken in this behalf under the Foreign Trade (Development and Regulation) Act, 1992, or rules and orders made thereunder, and the Customs Act, 1962.

(iii) Any information furnished in this application if proved incorrect, false, inaccurate, not current or misleading will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.

(iv) I/We further declare that no export proceeds areOutstanding beyond the prescribed period as laid down by the RBI, or such extended period for which RBI permission has been obtained. (v) I hereby certify that I am authorised to certify and Sign this declaration as per Paragraph 9.9 of the Policy.

(vi) I/We further undertake to submit to the DGFT (PC-III Section) a copy of the Bill of Entry into the destination State Party within 30 days of delivery failing which I/We shall be liable to action under the Foreign Trade (Development and Regulation) Act 1992, or Rules and Orders made thereunder and the Customs Acts, 1962.

Place:
Date :

Signature of the applicant ___________
Name in block letters _________________
Designation _________________
Official Address _________________
_________________
Residential Address _________________
E.Mail Address _________________

Note: Each page of this application should be signed individually by the Managing Director, or the Company Secretary or a Director of the firm. If signed by a Director of the firm, then that Director must be duly authorised to do so by the Board of Directors of the firm.

This Certificate is to be furnished by the exporters of Categories 1B & 1C items of Appendix-3

END USE CERTIFICATE

(To be furnished with reference to S. No.11 of this Export Licence Application)

We, (name of the end user), certify that we are importing _________________ M.T. of____________ from (name and address of exporter) for the manufacture of ______________(state specific use)

We further certify that we will not use the above mentioned chemical for any purpose other than stated as above nor transfer or re-export the item to any other party/country for any other purpose.

	Place:					Signature of end-user with Stamp and Seal
	Date:					Name:
						Designation:

Note:The exporter shall furnish a copy of confirmed export order indicating number and date to the customs and DGFT at the time of actual shipment.

This Certificate is to be furnished by the exporters of all other category items (except categories 1B & 1C) of Appendix-3

END USE/END USER CERTIFICATE

[Read instructions at foot of page]

1.      I/We  _____________________________ a/ hereby certify that  we
        are  the end-user of ________________________________ b/ to be
        imported  from  ____________________________  c/  against  our
        Purchase  Order  No.  ______________ dated __________ for  the
        manufacture of/used for __________________________ d/.

                                     OR
        The  undersigned, hereby declares that I am duly authorised to
        certify  that _____________________________________________ a/
        are  the  end-users  of the items detailed in  their  Purchase
        Order No.  ____________ dated __________ and are importing the
        said  items  from ___________________ c/ for  the  manufacture
        of/used for ___________________ d/.

2.      I/We further certify that the items detailed in the referenced
        Purchase Order will not be used for any purpose other than the
        purpose(s)  stated  in the Purchase Order, and that  such  use
        will  not  be  changed nor the items  modified  or  replicated
        without the prior consent e/ of the Government of India.

3.      The  end-user shall not himself, or through another, cause the
        items,   or   replicas,   or   derivatives   thereof   to   be
        re-transferred/sold  without  the knowledge/consent e/ of  the
        Government  of India, to any party within ________________  f/
        or outside it.

4.      I/We  also  certify  that  all the  facts  contained  in  this
        certificate  are true and correct to the best of my  knowledge
        and  belief and that I/we do not know of any additional  facts
        that are inconsistent with this certificate.



	Place:                                                                
                           			 __________________________________________
	Date :                      		Signature of end-user/authorised signatory
                                  			of end-user with stamp and seal

                            			Name : ___________________________________

                            			Designation : ____________________________

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Instructions:

a/ Name of end-user as at entry 24(c) of this Export Licence Application.

b/ Items entries as at Sl. No. 14 of this Application.

c/ Name and address of exporter in India.

d/ Name of the end product/end use.

e/ DGFT will state the condition in export licence. Do not strike out.

f/ Destination country.