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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..... risations which 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 regis .....

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..... Place: Signature of the Applicant Date: Name Designation Official Address Telephone Residential Address Email Address Documents to be enclosed with the application .....

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