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APPLICATION FORM FOR REQUEST FOR ENTERING INTO AN ARRANGEMENT OR UNDERSTANDING THAT INVOLVES SITE VISIT, ON-SITE VERIFICATION OR ACCESS TO RECORDS / DOCUMENTATION AS MENTIONED IN APPENDIX 3 TO SCHEDULE 2 OF ITC (HS) CLASSIFICATION OF EXPORT AND IMPORT ITEMS

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..... 2. Applicant Details: i. Name ii. Address 3. Applicant Fee Details: i. Amount in Rupees ii. Demand Draft/Bank Receipt/Electronic Fund Transfer Number iii. Date of issue/Transfer iv. Name of Bank on which drawn v. Bank Branch on which drawn 4. Jurisdictional Regional Authority: 5. Detail of activities and operations: 6. Details of the provisions of the arrangement or understanding involving site visits / on-site verificat .....

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..... of end user vi. End product for which the item of export will be used by the end user vii. Purpose for which the end product will be utilized viii. Is end user an entity of Government of destination country? ix. Manufacturing / Business / other activity of the end user 9. Details of export / import of SCOMET items in the preceding 3 licensing years: Sl.No. Export/Import Licence/Authorization Details Category Description of items Exported/Imported Qty. exported/imported Date of Shipment FOB Value of E .....

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..... 13. Detail of sites and activities which will be covered by the arrangement / understanding # (I) i. Address ii. Telephone No. iii. Fax No. iv. Nature of Unit: Corporate Office/Registered Office/Branch Office/Manufacturing unit/Laboratory. (v) Activity. (II) i. Address ii. Telephone No. iii. Fax No. iv. Nature of Unit: Corporate Office / Registered Office / Branch Office /Manufacturing unit / Laboratory. v. Activity. # Enclose .....

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..... RATION/UNDERTAKING 1. I/We hereby certify that : A. the entity for whom the application has been made have not been penalized under any of the following Acts (as amended from time to time): a. The Customs Act, 1962, b. The Central Excise Act 1944, c. Foreign Trade (Development Regulation) Act 1992, and d. The Foreign Exchange Management Act,1999; e. The Conservation of Foreign Exchange, Prevention of Smuggling Activities Act, 1974 f. Weapons of Mass Destruction their Delivery Systems (Prohibition of Unlawful Activities) Act, 2005 .....

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..... is application are true and correct to the best of my/our knowledge and belief and nothing has been concealed or withheld therefrom. 5. I / We hereby declare that I / We have not obtained nor applied for such benefits (including issuance of an Importer Exporter Code Number) in the name of our Registered / Head Office or any of our Branch(s) / Unit(s) / Division(s) to any other Regional Authority. 6. I / We solemnly declare that I / We have applied for / obtained a RCMC to the EPC which pertains to our main line of business. In case we have applied to any other council, the application has been made within the purview of the provisions of Para 2.94 of the HBP. .....

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..... s per details given below: (i) Copy of draft Declaration / draft Agreement / draft MOU proposed to be signed for entering into an Arrangement or Understanding that involves site visit etc. (ii) Technical Specifications (not exceeding one page for each item) for the items to be exported / imported. (iii) Profile of the foreign government / foreign third party / Indian party. 3. In case purpose of site visit / on-site verification is export / import, Original End User certificate (in the prescribed format Appendix 2R on Letter Head of the End User) indicating complete details of the export / import product, end product, end purpose for which the item of export / import will be used by end user alongwith complete address and teleph .....

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