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Application Form for Issuance of EPCG /Post Export EPCG Authorization

DGFT - ANF -5A - ANF- 5A () (Please see the guidelines before filling the application) 1. Application for Please tick (√) a. EPCG Scheme b. Post Export EPCG Scheme 2. IEC No. Branch Code Declaration: I/We have updated my/our profile in ANF -1. .....

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ctional Central Excise Authority (whether registered with central excise or not) 5. Port of Registration (for the purpose of imports) 6. Application Fee Payment details a. Amount (in Rs.) b. Mode of Payment (TR Challan/ Electronic Fund Transfer/Credit card) c. Serial .....

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d. Services for which registered 8. Sector Classification of Capital Goods sought to be imported under the Scheme (Please tick) a. Industrial Sector b. Agricultural Sector c. Service Sector d. Green Technology Sector .....

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ithin valid EO Period) Sl. No. Financial Year Total FOB Value of exports/services rendered for the same/similar product/services (Rs. in crores) 1 2 3 Total *Average export performance .....

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urrency)/Rs. Specific EO fulfilled Annual Average EO fixed (in Rs.) Expiry date of EO period 12. Details of Capital Goods sought to be imported Sl. No. Description of the items of import ITC(HS) Code Nature of Capital Goods sought to be imported* Quantity .....

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T Hqrs.) 14. Details of Restricted Capital Goods applied for import Sl. No. Description of the items of import ITC(HS) Code Nature of Capital Goods sought to be imported* Primary use of Capital Goods sought to be imported* * whether Capital Goods/Spares/Tools/Jigs/Fixtures/Dies/Moulds/Spare refractories/Catalyst (sp .....

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Details of Duty Total effective Customs duty on items to be imported (in %) CIF value of imports/deemed imports (in Rs.) Duty saved amount (in Rs.) 1 2 3 Note: In case of indigenous sourcing of CG, duty saved is to be calculated on notional customs duty saved on FOR value of capital goods as per Para 5.07 of FTP. .....

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paid (Rs.) Specific Export Obligation to be imposed Average Export Obligation to be imposed Rs. USD Rs. 19. Address of the factory/premises of the applicant or the supporting manufacturer where the capital goods to be imported are proposed to be installed 20. .....

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uthority, (if applicable) 21. Postal address of the jurisdictional Central Excise Authority in whose jurisdiction factory/premises of the applicant/supporting manufacturer where the capital goods to be imported are proposed to be installed Declaration/Undertaking I /we, hereby, declare/certify that: 1. The particulars and the statements made in this application are true and correct to the best of my/our knowledge .....

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amended from time to time. 3. None of the Proprietor/Partners(s)/Director(s)/Karta/Trustee of the firm/company has come under the adverse notice of DGFT or is in the caution list of RBI. 4. None of the Proprietor/Partners(s)/Director(s)/Karta/Trustee of the firm/company, as the case may be, is/are a Proprietor/Partner(s)/Director(s)/Karta/Trustee in any other firm/Company which has come under the adverse notice of DGFT or is in the caution list of RBI, to the best of my knowledge. 5. Neither the .....

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covered under service tax) 8. In respect of goods for which nexus is not established at a later date, I/We shall, without demur, pay to the Government Customs duty saved [together with applicable interest] on such imported goods which are found having no relation with product exported or service rendered. 9. I/We undertake to submit a self-certified copy of Drug Manufacturing Licences in case of export of Pharmaceutical Product(s) within a period of three years from the date of issue of EPCG Au .....

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. Place: Signature of the Applicant Date: Name Designation Official Address Residential Address Email Address Telephone No. (O) .....

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