Application for on line filing of Grant of Status Certificate

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....e 3. Exports of services without Weightage 4. FOR value converted in US $ for Deemed Exports 5. Exports of SEZs/EOUs/EHTPs/STPs/BTPs, if clubbing is sought 6. Total (in US$) Note1 A shipment can be included only once in one of the categories eligible for double weightage. Note 2: In case application is filed on basis of current years' exports, please specify the period (say e.g. Apr - July of Current Year if exports of 4 months are counted, or Apr - Nov of Current Year if exports of 8 months are counted) Note 3 If the exports are in any other currency other than US$ like Euro etc, these shall be converted to US$ as per rate notified by customs for particular month for export purposes. 5. This is to certify that I have uploaded the following documents after scanning which is part of this application. a. Copy of earlier Status Certificate, if any. 6. DECLARATION /UNDERTAKING 1 I/We hereby certify that : A. the entity for whom the application has been made have not been penalized under any of the following Acts (as amended from time to time): (i) The Customs Act, 1962, (ii) The Central Excise Act 1944, (iii) Foreign Trade (Development & Regulation) Act 1992, (iv) The ....

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....OUNTANT (ICWA)/ COMPANY SECRETARY (CS) I / We hereby confirm that I / We have examined prescribed registers and also relevant records of M/s ....... .............……………………………………………having IEC Number ……………………... for licensing period (s) …… …………………………and hereby certify that: 1 Following documents / records have been furnished by applicant firm / company and have been examined and verified by me / us namely: - a) Statutory documentations under Customs Act 1962 and Excise Act 1848, Service Tax Act, Foreign Trade (Development & Regulation) Act 1992 as amended; b) Export Order / Contract, Shipping Bills, Bill of Lading (and / or Airways Bills / PP Receipts), Customs / Bank attested Invoices, Forward Inward Remittance Certificates (FIRCs) and e- BRC realization, GR declaration and connected books of accounts; c) FIRCs, Certificate from international credit card companies. 2 Information given by applicant firm / company in ANF 3C i....

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....: If the exports are in any other currency other than US$ like Euro etc, these shall be converted to US$ as per rate notified by customs for particular month for export purposes. 7. This is to certify that following of documents of record mentioned in serial number 1 have not been maintained/furnished, examined or verified 1) 2) 8. I / We fully understand that any statement made in this certificate, if proved incorrect or false, will render me / us liable to face any penal action or other consequences as may be prescribed in law or otherwise warranted. Place: ______________ Signature of CA/ ICWA / CS:_______________________ Date: _______________ Name of the Signatory: ______________________ Address: ________________________________ ____________________________________ Membership No: ___________________________ Phone Number Email Address: ______________________________ Format A Certificate of Exports where Double Weightage has been claimed (Applicable only if the application is for One Star Export House) Note: A shipment can be included in one of categories indicated below only once. Sl.No. Category of Exports FOB/FOR/Foreign Exchange earned in US $ in Current Ye....

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...._______ Note: Each page of certificate of Chartered Accountant (CA)Cost and works Accountant ICWA)/ Company Secretary (CS) including Format A to D need to be signed and stamped.] -------------------------- Notes:- 1. Substituted vide PUBLIC NOTICE No.05/2015-20 Dated: 3rd May, 2016, before it was read as, "ANF- 3C Application for on line filing of Grant of Status Certificate (Kindly read Para3.20 to 3.24 of FTP and Para 3.18 to3.23 of HBP ) Part A 1. Applicant Detail IEC Number Branch Code Name Address Telephone No Email ID 2. Application Details Application For Submission Date Submitted To Part B 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 4. Details of Exports/Deemed Exports/Foreign Exchange earned for supply of Service from India during preceding two licensing years and current year (i.e. year in which application is filed). Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service Type of Exports in US $ (FOB / FOR value / Foreign Exchange Earned) Current Year in US $(Speci....

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....herefrom. 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 Paragraph 9.06 of the Foreign Trade Policy. 5 I hereby declare that a shipment has been included only once in one of the categories eligible for double weightage. 6 I hereby declare that exports made on re-export basis have not been included. 7 I hereby declare that export / supplies do not include any performance based on disclaimer . 8 I hereby declare that only such exports has been taken into account for seeking recognition, which has been realized by me in our bank account directly from overseas. 9 I undertake to abide by provisions of Para 9.51 of FTP relating to supply of service from India. Tick the box as acceptance of declaration/ undertaking and fill in the details below. Signature of the Applicant Name Designation Official Address Flat/Plot/Block No Street/Area/Locality City State PIN Code Telephone No. Country Code __ Area Code _____ Phon....

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....anies or its associated concerns; 5 I / We further certify that export proceeds for shipments during last two years 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 by Supply of Service from India Type of Exports in US $ (FOB / FOR value / Foreign Exchange Earned) Current Year in US $ Previous Year 1 in US $ Previous Year 2 in US $ 1. Exports of goods without Weightage 2. Exports with Double Weightage (As per format A) 3. Exports of services without Weightage(As per Format B ) 4. FOR value converted in US $ for Deemed Exports( As per Format C) 5. Exports of SEZs / EOUs / EHTPs / STPs / BTPs, if clubbing is sought(As per format D 6. Total (in US$) Note1: A shipment can be included only once in one of the categories eligible for double weightage. Note 2: In case application is filed on basis of current years' exports, please specify the period (say e.g. Apr - July of Current Year if exports of 4 months are counted, or Apr - Nov of Current Year if ....