Application Form for Clubbing of EPCG Authorizations

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..... ort of Registration Customs Notification No. Product(s) to be exported/ Services to be rendered Number Date 1 2 3 4 5 6 Duty saved amount (in INR.) Duty saved utilized (in INR.) Specific EO endorsed on the Authorization (in US $) Specific EO as per utilization (in US$) EO Fulfilled (in US $) 7 8 9 10 11 3. Details of EPCG Authorization after clubbing .....

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..... e/ Karta/ Proprietor of the firm/company has come under the adverse notice of DGFT or is in the caution list of RBI. 4. None of the Partners(s)/Director(s)/Trustee/Karta/Proprietor of the firm/company, as the case maybe, is/are a Proprietor/Partner/Director/Karta/Trustee in any other firm/Company which has come under the adverse notice of DGFT or is in the caution list of RBI, to the best of my .....

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..... f EPCG authorisation and each page of the application would need tobe signed by the applicant. 1. Appendix 5C duly signed by Chartered Accountant/Cost Accountant/Company Secretary along with a statement giving details of the documents submitted by the authorization holder towards evidence of EO fulfillment. 2. Original/Copies EPCG authorization along with enclosures as may be applicable. .....

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