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APPLICATION FORM FOR STATUS HOLDER CERTIFICATE

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..... 3. Category of Status applied for: please tick) ( ) a) One Star Export House b) Two Star Export House c) Three Star Export House d) Four Star Export House e) Five Star Export House Part B Export Performance Details 4. Details of Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service from India during preceding three (two for Gems and Jewelry Sector) financial years and current year (i.e. year in which application is being filed). Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service from India Type of Exports in USD (FOB / FOR value / Foreign Exchange Earned) Current Year in USD (Specify Period) Previous Year 1 in USD Previous Year 2 in USD Previous Year 3 in USD (not applicable for Gems and Jewelry Sector) .....

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..... % age of Top 5 service categories in total service exports of last financial year - % 7. For information dissemination on DGFT Portal of List of Status Holders, the following details are to be provided by all Star Export Houses : 7.1 Brief Description of the Business (in 100 word) : Upload: Product Brochure in PDF 7.2 Link of the Website: 7.3 : Email ID for Business Enquires: Part D - Skilling and Mentorship Obligation 9. Details to be provided by the Status Houses (2 star houses and above) as part of skilling and Mentorship Obligation mandated in Para 1.30 of FTP 2023 9.1 Details of the Intended Training to be taken up : Financial Year (For current and next 5 years) Duration of the training Program (In Weeks) District of the Training Program Likely number of Trainees intended be taken Likely Venue of the Training Start Date (Month in MM/YY) End Date (Month MM/YY) .....

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..... een made ineligible for undertaking import / export under any of the provisions of the Policy; 2. I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, as amended from time to time, the Rules and Orders framed there under the Foreign Trade Policy and the Handbook of Procedures 3. I/We hereby certify that that particulars and statements made in this application are true and correct and nothing has been concealed or held there from. I/We fully understand that any information furnished in the application, if found incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted. 4. I hereby certify that I am authorized to verify and sign this declaration as per Foreign Trade Policy. 5. I hereby declare that a shipment / service export transaction has been included only once in one of the categories eligible for double weightage. I also understand that service transactions which are as per para 11.51 of the FTP has b .....

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..... pment is 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. d) If the exports are in any other currency other than USD like Euro etc, these are converted to USD as per rate notified by customs for export purposes. e) If the eligible exports are Deemed Exports or have had realizations in Indian Rupees, the same has been converted to USD as per rate notified by customs for export purposes. 4. Neither I, nor any of my / our partners is a partner, director, or an employee of above-named entity, its Group companies or its associated concerns; 5. I / We further certify that export proceeds for shipments during last three years (two years for Gems and Jewelry Sector) plus current year are not outstanding beyond prescribed period as permitted by RBI. 6. The statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service has been calculated as under: Statement of Exports / Deemed Exports / Foreign Exchange Earned b .....

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..... Format A Certificate of Foreign Exchange Earned by Supply of Service Sl.No. Category of Service Provider Particulars Foreign Exchange Earned USD in current year Foreign Exchange Earned USD in previous year 1 Foreign Exchange Earned USD in previous year 2 Foreign Exchange Earned USD in previous year 3 (not applicable for Gems and Jewelry Sector) 1 Mode 1 as per Chapter 11 2 Mode 2 as per Chapter 11 3 Mode 3 as per Chapter 11 4 Mode 4 as per Chapter 11 5 Total Foreign Exchange Earned by Supply of Service (USD) .....

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..... 2 7.02(b) 3 7.02(c) 4 7.02(d) 5 7.02(e) 6 7.02(f) 7 7.02(g) 7 Total FOR Value (Rs in Cr) 8 Total Equivalent USD Format D Receipts under Para 2.53 of FTP Sl. No. Receipts under Para 2.53 of FTP Equivalent Foreign Exchange Earned USD in current .....

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