Form of Self Declaration for obtaining Duplicate Copy of freely transferable Licences / Authorisations which are lost or misplaced (as per para 2.23 and 2.24 of HBP)

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..... ch are lost or misplaced (as per para 2.23 and 2.24 of HBP) To The Regional authority I/We hereby solemnly affirm and declare that customs purpose copy/exchange purpose copy/both the copies of Licence No. / Authorisation No.___________dated__________ issued to me/us have been lost/ misplaced, without having been registered with any Customs House / after having been registered with _____________ .....

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..... Signature of the Applicant Date: Name Designation Official Address Telephone Residential Address Email Address Documents to be enclosed with the application form As per para 2.24 duplicate copy of freely transferable Authorisation may be issued against an application accompanied with following documents: 1. An application with fee equivalent to 10% of duty saved or duty credit (of unutil .....

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