ANNEXURE- 6 - MINIMUM REQUIRED INFORMATION - Customs Tariff (Determination of Origin of Goods under the Comprehensive Economic Cooperation and Partnership Agreement between the Republic of India and the Republic of Mauritius) Rules, 2021

ANNEX 6 - MINIMUM REQUIRED INFORMATION (See Rule 17) 1. Name and Address of the Exporter /Manufacturer: 2. Registration Number: 3. Country of origin: All cost and price figures are to be shown in United States of America dollars ($)/national currency 4. Export Product-wise general information: S. No. Description of the good to be exported Model/Brand HS code FOB value 5. Good - wise material cost information (to be furnished for each good listed in Para 4 above): A B C D E F G H Sl. No. Description of component, materials, inputs, parts or produce Quantity and Unit Unit CIF Value Total CIF Value HS Code (at six digit level) Supplier s name and address Country of Origin of the component, materials, inputs, parts or produce In column H, the entry shall be made to indicate the Country of Origin in terms of the Rules of Origin as one of the following: - (i) India; (ii) Other Party; (iii) non-originating materials used in production. 6. Calculation (i) Value of non-originating materials used in production as a percentage of FOB value: ____ (ii) Value of originating materials as a percentage of FOB value: _____ 7. Description of the manufacturing process: DECLARATION I declare that the information provided by me as above is true and correct. I will permit, as and when required, inspection of our factory/good and undertake to maintain up to date costing records. Signature, Name and Designation of the signatory FOR OFFICIAL USE The particulars given above have been checked, verified by the records maintained by the applicant and found to be correct. On the strength of this evidence, the applicant is eligible to claim that the products have originated from ____________ as shown in serial number 3 above in terms of the provisions of Rules of Origin of the Agreement. Place and Date: Signature and Name of the Competent Authority with Official Seal