[See rule 13]

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..... e Exporter /Manufacturer: 2. Registration Number: 3. Country of origin: All cost and price figures are to be shown in US dollars ($) 4. Export Product-wise general information: S. No. Description of the product Model/Brand HS code FOB / ex-works value .....

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..... .....

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..... ion of our factory/products and undertake to maintain up to date costing records. Signature, Name and Designation of the signatory FOR OFFICIAL USE The particulars given above have been checked, verified by the records maintained by the applicant and found to be correct .On the strength of this evidence, the applicant is eligible to claim that the products have originated from ______ .....

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