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Application for Issue of Nominated Agency Certificate (NAC) / Renewal of Nominated Agency Certificate

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..... e held (Please tick) Four Star Export House / Five Star Export House Number of Status Certificate Date: Validity: 5. Nature of concern (Please tick mark) I Merchant Exporter ii Manufacturer Exporter iii Service Provider iv Merchant cum Manufacturer v Others Please specify 6 RCMC Number Dae Issuing Authority Validity Period Products for which registered 7 Application Fee details - Sr. No. Receipt/Electronic Fund Transfer No. / Credit Card Name of the Bank Branch Pay Mode Date Amount (in Rs.) .....

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..... Import Items as well as RBI and Customs guidelines, as amended from time to time, as applicable to Nominated Agencies. 4. None of the Proprietor/ Partner(s) / Director(s) / Karta / Trustee of the firm / company, as the case may be, is / are a Proprietor / Partner(s) I Director(s) / Karta / Trustee in any other firm / Company which has come to the adverse notice of DGFT or in the caution list of RBI to the best of my knowledge. 5. that I/we have perused the list of SCOMET items as contained in the Appendix 3 to the Schedule 2 of the ITC (HS) Classifications of Export-Import Items, and that the item(s) exported / proposed to be exported does not fall within this list and that l/ We agree to abide by the provisions of the Policy for export of SCOMET items contained in the Foreign Trade Policy, Schedule 2 of ITC (HS) and the HBP, irrespective of the scheme under which the item is exported I proposed to be exported (the underlined portion will be deleted in case an application for export license for SCOMET item is being filed). 6. no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which RBI permission has been o .....

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..... been included for calculating the eligibility for Nominated Agency Certificate. 4. 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 can 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. 5. Neither l, nor any of my / our partners is a partner, director, or an employee of above-named entity, its Group companies or its associated concerns; 6. If any of documents of record mentioned in serial number (i) have not been maintained / furnished, examined or verified, they may please be specified below:- Place: Date: Signature of CA/ ICWA / CS: Name of the Signatory: Membership No: Address: e-mail Address: ] ----------------- Notes:- 1. Substituted vide Public Notice No. 37/2015-2020, dated 04-10/ .....

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..... Validity Period Products for which registered 7 Application Fee details- Sr. No. Receipt/Electronic Fund Transfer No. / Credit Card Name of the Branch Bank Pay Mode Date Amount (in Rs) 8 Excise Registration Number Address of the jurisdictional Central Excise Authority under whose jurisdiction the factory / premises situated. Address of the factory / premises where the items to be imported are proposed to be used Part B 9. Details of Exports / Deemed Exports / Foreign Exchange earned during preceding licensing years and current year (i.e. year in whic .....

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..... s) exported / proposed to be exported does not fall within this list and that I/ We agree to abide by the provisions of the Policy for export of SCOMET items contained in the Foreign Trade Policy, Schedule 2 of ITC (HS) and the HBP, irrespective of the scheme under which the item is exported / proposed to be exported (the underlined portion will be deleted in case an application for export license for SCOMET item is being filed). 6. 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. that I/We have updated the IEC profiles in ANF-1 8. I am authorised to verify and sign this declaration as per Paragraph 9.06 of the FTP. Place: Signature of the Applicant Date: Name Designation Official Address Telephone Residential Address .....

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