APPENDIX-11 E APPLICATION FORM FOR OFFSETTING OF OBLIGATION UNDER DUTY ENTITLEMENT PASS BOOK (DEPB) ON PRE EXPORT BASIS

----------------------------------------------------------------------------------------------------------------------------------------------------Note: 1. Please see Paragraph 7.46 of the Handbook(RE-99). 2. Please read the general instructions given Appendix 1 before filling this application. 3. Please submit 2 copies of this application form. FOR OFFICIAL USE File No. 1. Name and address of the Applicant Date: ............... : ............................................ : ........................................... : ............................................ :In figures Rs. .............................. :In words Rs. .............................. : In figures Rs. ............................. : In words Rs. ............................. Customs House (4) Bank Certificate No. and date (5)

2.

IEC Number

3. Total FOB value of Exports realised 4. Total DEPB entitlement claimed (in Rs.) 5. Details of exports made S.No (1) S/Bill No and Date (2)

FOB value as per Shipping Bill (3)

Product group Code No. (6)

Sl.No. of DEPB rate list (App.28A) (7)

Description as per S/Bill (8)

FOB as per Bank Certificate (9)

DEPB Rate

Value of DEPB earned (Rs.) (11)

(10)

Total: ..................................................................... Note: For Product Group Code No. refer to Appendix-1.

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6. DEPB already claimed on pre export basis S.No [1] File No and name of licensing authority [2] Value ( Rs.) [3] DEPB No. and date [4]

7.

Balance value for DEPB is to be issued OR

which

Rs..........................................

Balance value of DEPB which duty and interest payable. 8.

on is : : :

............................................

Application fee for balance DEPB: Bank Receipt/DD No. and date Issued by:

............................................ ............................................ ............................................

DECLARATION/UNDERTAKING
--------------------------1 I/We hereby declare that the particulars and the statements made in this application are true and correct to the best of my /our knowledge and belief and nothing has been concealed or held therefrom. I/We fully understand that any information furnished in the application if proved incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted. I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, the Rules and Orders framed thereunder, the Export and Import Policy and the Handbook of Procedures. I/We hereby declare that no DEPB has been claimed particulars of the shipping bills given above. earlier pertaining to the

4 5

I/We further declare that no export proceeds are outstanding beyond the prescribed period as laid down by the RBI ,or such extended period for which RBI permission has been obtained. I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 3.8 of the Policy. I/We further declare that in case of non realisation of export proceeds or lesser realisation of export proceeds, we shall pay, in cash, an amount equivalent to the duty free import benefits availed against DEPB entitlement already obtained on the non realised or lesser realised value of export proceeds together with 24% interest reckoned from the date of duty free imports to the date of payment (Applicable only in case of exports made against irrevocable Letter of Credit). Signature of the Applicant:.............. Name: Designation: Official Address: Tele.No : ................. ................. ................. .................

6 7

Place : Date :

E-Mail Address :..................

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-----------------------------------------------------------------------------Documents to be enclosed with the application form: -----------------------------------------------------------------------------1. Bank Receipt (in duplicate)/Demand application fee in terms of Appendix-34. 2. E.P Copy of DEPB shipping Bills. 3. Bank Certificate of Exports and Realisation in Appendix- 25. Draft evidencing payment of

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