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Application for on line filing of Grant of Status Certificate

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..... supply of Service from India during preceding three ( two for Gems and Jewellery Sector) licensing years and current year (i.e. year in which application is filed). Statement of Exports/Deemed Exports/Foreign Exchange Earned by Supply of Service Type of Exports in US $ (FOB/FOR value/Foreign Exchange Earned) Current Year in US $(Specify Period) Previous Year 1 in US $ Previous Year 2 in US $ Previous Year 3 in US $ ( not applicable for Gems and Jewellery Sector ) 1. Exports of goods without Weightage 2. Exports with Double Weightage 3. Exports of services without Weightage 4. FOR value converted in US $ for Deemed Exports 5. Exports of SEZs/EOUs/EHTPs/STPs/BTPs, if clubbing is sought 6. Total (in US$) Note1 A shipment can be included only once in one .....

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..... ue and correct and nothing has been concealed or held therefrom. I/We fully understand that any information furnished in the application if found incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted. 4 I hereby certify that I am authorized to verify and sign this declaration as per Paragraph 9.06 of the Foreign Trade Policy. 5 I hereby declare that a shipment has been included only once in one of the categories eligible for double weightage. 6 I hereby declare that exports made on re-export basis have not been included. 7 I hereby declare that export / supplies do not include any performance based on disclaimer . 8 I hereby declare that only such exports has been taken into account for seeking recognition, which has been realized by me in our bank account directly from overseas. 9 I undertake to abide by provisions of Para 9.51 of .....

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..... n furnished is true and correct in all respects; no part of it is false or misleading and no relevant information has been concealed or withheld; b) In respect of export of goods, a shipment is counted in applicants export turnover / performance only if the realization of export proceeds from overseas is in the applicant s bank account. c) In respect of service providers, realization of export proceeds in free foreign exchange pertains to rendering of services. d) If the exports are in any other currency other than US$ like Euro etc, these are converted to US$ as per rate notified by customs for particular month for export purposes. 4. Neither I, nor any of my / our partners is a partner, director, or an employee of above-named entity, its Group companies or its associated concerns; 5. I / We further certify that export proceeds for shipments during last three years (two years for Gems and Jewellery Sector) plus current year are not outstanding beyond prescribed period as permitted by RBI. 6. The statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service has been calculated as under: Statement of Exports/Deemed Exports .....

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..... ne Number Email Address: ______________________________ Format A Certificate of Exports where Double Weightage has been claimed (Applicable only if the application is for One Star Export House) Note: A shipment can be included in one of categories indicated below only once. Sl.No. Category of Exports FOB/FOR/Foreign Exchange earned in US $ in Current Year FOB/FOR/ Foreign Exchange earned in US $ in Previous Year 1 FOB/FOR/ Foreign Exchange earned in US $ in Previous Year 2 FOB/FOR/ Foreign Exchange earned in US $ in Previous Year 3(not applicable for Gem and Jewellery Sector) 1. Export of Goods and/or services by Micro, small medium enterprises(MSME) as defined in Micro, small medium enterprises Development (MSMED) Act 2006 2. Manufacturing units having ISO/BIS 3. Units located in North Eastern States including Sikkim and Jammu Kashmir .....

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..... CBEC as on 1 st April of financial year 9. Equivalent US $ Format D Exports from SEZs / EOUs / EHTPs / STPs / BTPs units which are included in IEC and is taken for calculation of grant of status Sl.No. Names of Exporting Units FOB value in US $ in current year FOB value in US $ in previous year 1 FOB value in US $ in previous year 2 FOB value in US $ in previous year 3 (not applicable for Gem and Jewellery Sector) 1 2 3 4 5 1 SEZs 2 EOUs 3 EHTPs 4 STPs 5 BTPs 6. Total FOB Value (in US$) .....

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..... in which application is filed). Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service Type of Exports in US $ (FOB / FOR value / Foreign Exchange Earned) Current Year in US $(Specify Period) Previous Year 1 in US $ Previous Year 2 in US $ 1. Exports of goods without Weightage 2. Exports with Double Weightage 3 . Exports of services without Weightage 4. FOR value converted in US $ for Deemed Exports 5. Exports of SEZs / EOUs / EHTPs / STPs / BTPs, if clubbing is sought 6. Total (in US$) Note1 A shipment can be included only once in one of the categories eligible for doubl .....

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..... r, the Foreign Trade Policy, the Handbook of Procedures 3. I/We hereby certify that that particulars and statements made in this application are true and correct and nothing has been concealed or held therefrom. I/We fully understand that any information furnished in the application if found incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted. 4 I hereby certify that I am authorized to verify and sign this declaration as per Paragraph 9.06 of the Foreign Trade Policy. 5 I hereby declare that a shipment has been included only once in one of the categories eligible for double weightage. 6 I hereby declare that exports made on re-export basis have not been included. 7 I hereby declare that export / supplies do not include any performance based on disclaimer . .....

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..... d by applicant firm / company and have been examined and verified by me / us namely: - a) Statutory documentations under Customs Act 1962 and Excise Act 1848, Service Tax Act, Foreign Trade (Development Regulation) Act 1992 as amended; b) Export Order / Contract, Shipping Bills, Bill of Lading (and / or Airways Bills / PP Receipts), Customs / Bank attested Invoices, Forward Inward Remittance Certificates (FIRCs) and e- BRC realization, GR declaration and connected books of accounts; c) FIRCs, Certificate from international credit card companies. 2 Information given by applicant firm / company in ANF 3C is in agreement with FTP,2015-20 as amended, and rules and procedures made there under, relevant register and records and books of accounts maintained by M/s ......... .. ... is also true and correct. 3 It has been ensured that a) Information furnished is true and correct in all respects; no part of it is false or misleading and no relevant information has been concealed or withheld; b) In respect of export of goods, a shipment is counted in applicants export turnover / performance only if the realization of export proceeds from overs .....

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..... ote 3: If the exports are in any other currency other than US$ like Euro etc, these shall be converted to US$ as per rate notified by customs for particular month for export purposes. 7. This is to certify that following of documents of record mentioned in serial number 1 have not been maintained / furnished, examined or verified 1) 2) 8. I / We fully understand that any statement made in this certificate, if proved incorrect or false, will render me / us liable to face any penal action or other consequences as may be prescribed in law or otherwise warranted. Place: ______________ Signature of CA/ ICWA / CS:_______________________ Date: _______________ Name of the Signatory: ______________________ Address: ________________________________ ____________________________________ Membership No: ___________________________ Phone Number .....

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..... Para 9.51 (iii) 4 Para 9.51 (iv) 5. Total Foreign Exchange Earned by Supply of Service (US$) Format C Certificate of FOR value of Deemed Exports Sl. No. Category of Deemed Exports (Chapter 7 of FTP) (Please quote the relevant sub para in brackets) FOR (Rs in Cr) in current year FOR (Rs in Cr) in previous year 1 FOR (Rs in Cr) in previous year 2 1 Supply to Advance Authorisation 2 3 4 .....

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