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Application for Clubbing and Closure of Advance Authorisations

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..... orsed in Authorisation Authorisation Number Export Serial No. SION Serial No. Item(s) to be exported / supplied Quantity UOM Total FOB/FOR Value (INR) Total FOB / FOR Value (in USD) Export FCC in Authorisation Total FOB / FOR value (in export FCC) ITC (HS) Code Export item technical characteristics / Description As per Shipping Bills/GST Invoice/Bill of Exports Authorisation Number Shipping Bill Number/ Bill of Exports number/ GST Invoice Number Shipping Bill /Bill of Exports /GST Invoice Date Invoice Number Invoice Date Invoice Serial Number Quantity UOM Total F .....

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..... CIF Value (INR) Export FCC in Authorisation Total CIF Value(in Foreign Currency) Total CIF Value (in USD) Input As per Bill of Entries/GST Invoices Authorisation Number BOE/ GST Invoice Number BOE/ GST Invoice Date Invoice Serial Number Input Item Description in invoice ITC (HS) Code Quantity UOM Total CIF Value (INR) Foreign Currency as per Invoice Total CIF Value(in foreign currency) Foreign currency exchange rate in INR (as per invoice date) Total CIF Value (in Applicable foreign currency) .....

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..... Serial Number from Appendix 4J Remarks Free of Cost As endorsed in Authorisation Input Serial No Export Serial No Item name Authorisation Number Item Description Source Country Destination Country Quantity UOM Notional Value (INR) Notional Value (in foreign currency) Notional Value (in USD) FCC as per Authorisation Notional Value (in Applicable FCC) ITC(HS) Code Drawback Details As endorsed in Authorisation Authorisation Number Item Description Quantity Required Quantity Invalidated Quantity to be imported UOM Type of Import CIF Value/ Value of Item (In Rs) CIF Value/ Value of Item (In foreign currency) CIF Value/ Value of Item (In USD) FCC as per Authorisation .....

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..... UOM Input Name Quantity UOM Bond Waiver Details Export Item Name Quantity UOM Input Name Quantity UOM Surrender Details Export Item Name Quantity UOM Input Name Quantity UOM .....

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..... iv) The Foreign Exchange Management Act, 1999; (v) The Conservation of Foreign Exchange, Prevention of Smuggling Activities Act, 1974. 10. I am authorised to verify and sign this declaration as per Paragraph 11.06 of the FTP. . Tick the box as acceptance of declaration/ undertaking and fill in the details below. Place Date Name Designation Email Mobile Office Address Residential Address DSC / E-Sign Details S.No. E-sign Type Serial Number Signed Date Certificate Type Certifying Authority Common Name Organisation Certificate Issued Date Certificate Expiry Date .....

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