Procedure

APPENDIX - 4

Document type: Procedure
Dated: 04 Feb 2013
Category: Forms & Appendix (01/04/2003 to 31/08/2004)

FORM OF APPLICATION FOR REGISTRATION CUM MEMBERSHIP WITH EXPORT PROMOTION COUNCILS

APPENDIX - 4
FORM OF APPLICATION FOR REGISTRATION CUM MEMBERSHIP WITH EXPORT PROMOTION COUNCILS
NOTE: Please see paragraph 2.44 of the Policy and paragraph 3.12.2 of Handbook (Vol.1)

FOR OFFICIAL USE

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

To,
The

Dear Sir,

Kindly register us as Merchant/Manufacturer/Merchant cum Manufacturer exporter of the export product(s) mentioned below.

1.	Name of the applicant	: _________________________
1A.	E-Mail address	: ------------------------------
2.	(i) Address of the applicant. (Registered Office in case of limited companies, and the head office for others)	: __________________________ ___________________________ ___________________________
	(ii) Name address of the branches, if any	: __________________________ ___________________________ ___________________________ ___________________________
	(iii) Name and address of the factory.	: __________________________ ___________________________ ___________________________
4	If the registration is required as a manufacturer exporter SSI Registration Industrial Licence/IEM	: No. ________________________ Date _________________________ Issuing Authority: _______________
4	Others (specify)	: __________________________
5.	EH/TH/STH/SSTH certificate number.	: Valid upto ______________
7.	Name of export product(s) for which registration is required.	: ____________________________
8.	I/We hereby solemnly declare that the above stated information is true and correct. I/We undertake, without any reservation, to: (a) abide by the terms of the registration certificate granted to us on all our exports; (b) agree to abide by any code of conduct that may be prescribed; (c) agree to abide by export floor price condition that may be stipulated by the Registering Authority; (d) Furnish without fail monthly returns of exports including NIL returns to the Registering authority by 15th day of the months following the quarter.
9.	We further understand that our registration is liable to be canceled in the event of breach of any of the undertakings mentioned above.
Yours faithfully, (Signature)
	Name	___________________________.
	Address	___________________________.
	Designation	___________________________.
	Tele No:	___________________________.
	Fax No:	___________________________.
	Residential address:	___________________________. ___________________________.

Place _______________
Date _______________

Documents to be enclosed with the application form:

1. A self certified copy of the IEC Number issued by the licensing authority concerned.

2. A certificate from the bank in support of the applicant"s financial soundness.

APPENDIX - 4

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