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Application for Gem Replenishment Authorisation

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..... RCMC Details RCMC Number Date of Issuance Validity Period Issuing Authority Products for which registered Excise GST Details Branch code .....

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..... FOB value in USD FOB value realized in the foreign currency code Foreign Currency code Repository Data Description of Item of Exports Total FOB (In INR) Total FOB (In USD) .....

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..... FOB) FOB value Realised (INR) FOB value Realised (USD) Replenishment Authorisation Claimed (INR) After Late cut Replenishment Authorisation Claimed (USD) After Late cut Value of Authorisation Claimed as per Appendix 4F (in USD) Value of Authorisation Claimed as per Appendix 4F (in INR) ii) Details as per Appendix. Sr.No Shipping Bill No. Shipping Bill Date LEO Date Latest Date of Realisation as .....

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..... Value of Authorisation Claimed as per Appendix 4F (in USD) Value of Authorisation Claimed as per Appendix 4F (in INR) Totals Total Value of Authorisation Claimed(ln INR) Total Value of Authorisation Claimed(ln USD) Attachment Details Attachment Type Remark Attachment Name DECLARATION / UNDERTAKING 1. I/We hereby declare that the particulars and the statements made in this application are true and correct to the best of my / .....

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..... 6. I / We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which RBI permission has been obtained. 7 I hereby certify that 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 .....

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