ANF 4 I

GEM REP
Application
[Please see guidelines (given at the end) before filling the application]

1. IEC Number

2. Applicant Details

i. Name
ii. Address

3. RCMC Details

i. RCMC Number
ii. Date of Issue
iii. Issuing Authority
iv. valid upto
Products for which registered

4. Type of Exporter (please tick)

(√)
i. Merchant Exporter
ii. Manufacturer Exporter
iii. Service Provider
iv. Others (please specify)
v. Merchant cum Manufacturer

5. Industrial Registration Details

i. SSI / IEM / LOI or IL Registration Number

ii. Date of Issue
iii. Issuing Authority
iv. Products for which registered

6. Excise Details (For those registered with Central Excise Authority)

i. Excise Registration Number

ii. Issuing Authority

7. Application Fee Details

Amount (Rs)
Demand Draft / Bank Receipt / Electronic Fund Transfer No
Date of Issue
Name of the Bank on which drawn
Bank Branch on which drawn

8. Export Proceeds Realisation Month:

9. FOB Value of Exports

i. In free foreign exchange

ii. In Rupees
10. Value of Authorisation Claimed

i. In free foreign exchange

ii. In Rupees

11. Details of exports made

Name of the Bank Shipping Bill/ Postal FOB Value FOB Value REP Authorisation Country of Exports
Receipt ( in FFE / Rs ) realised Claimed ( Rs )
Number Date ( in FFE / Rs )

Note: In case application for REP Authorisation is made under Para 4A.28 of this handbook, serial no 11 may be left blank.

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 there from. If found incorrect or false, it will render me
/ us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.
2. I/We undertake to abide by the provisions of FT(D&R) Act, the Rules and Orders framed there under, the FTP, HBP v1,
HBP v2 and the ITC(HS) Classification of Export & Import Items.
3. I / We hereby certify that none of the Proprietor / Partner(s) / Director(s) / Karta / Trustee of the firm / company, as the
case may be, is / are a Proprietor / Partner(s) / Director(s) / Karta / Trustee in any other firm / Company which has come
to the adverse notice of DGFT.
4. I/We hereby certify that the Proprietor / Partner(s) / Director(s) / Karta / Trustee, as the case may be, of the firm/company
is / are not associated as Proprietor / Partner(s) / Director(s) / Karta / Trustee in any other firm/company which is in the
caution list of RBI.
5. I / We hereby declare that I / we have perused the list of SCOMET items as contained in the Appendix 3 to the
Schedule
2 of the ITC (HS) Classifications of Export-Import Items and that the item(s) exported / proposed to be exported does
not
fall within this list and that I / We agree to abide by the provisions of the Policy for export of SCOMET items contained
in the Foreign Trade Policy, Schedule 2 of ITC (HS) and the HBP v1, irrespective of the scheme under which the item
is exported / proposed to be exported (the underlined portion will be deleted in case an application for export license
for SCOMET item is being filed).
6. I / We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such
extended period for which RBI permission has been obtained.
7. I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 9.9 of the FTP.

Signature of the Applicant Place

Name Date

Designation
Official Address
Telephone
Residential Address
Email Address
 Annexure to ANF 4I

CERTIFICATE OF CHARTERED ACCOUNTANT

COST AND WORKS ACCOUNTANT

I/We hereby confirm that I/We have examined the prescribed registers and also the relevant records of
M/s..........................……………………………………………having IEC number……………………... and PAN
number…………………….for the licensing period(s) ………………………………and hereby certify that:

(i) The following documents/ records have been furnished by the applicant firm/company and have been
examined and verified by me/us namely: -

c. Statutory documentation under the Customs Act 1962 and Excise Act 1848, Service Tax
Act, Foreign Trade (Development & Regulation) Act 1992;
d. Export Order/Contract, Shipping Bills, Bill of Lading (and/or Airways Bills/PP Receipts),
Customs/Bank attested Invoices, Bank Certificates of exports made in their own name, GR
declaration etc and connected books of accounts;

(ii) The relevant accounting and financial register(s) as prescribed under different Acts and Rules made there
under have been maintained and authenticated under my/our seal and signature.

(iii) The information given by the applicant firm/company in the ‘Aayaat Niryaat Form’ including details on
a. imports/exports made,
b. foreign exchange earnings/ realization (both from direct and indirect sources)

is in agreement with the Foreign Trade Policy 2009-14 and the rules and procedures made there under, the
relevant register and records and the books of accounts maintained by M/s...........…………………... and their
subsidiaries and is also true and correct.

(iv) It has been ensured that the information furnished is true and correct in all respects; no part of it is false or
misleading and no relevant information has been concealed or withheld;

(v) Neither I, nor any of my/our partners is a partner, director, or an employee of the above-named entity, its
Group companies or its associated concerns;

(vi) I/We further certify that M/s..................………………………. has realised 95% or more of the export proceeds
in respect of exports made by him in the preceding three licensing years [excluding the export made during
last 360 days (for status holders) and six months for others, from the date of filing of application]

(vii) 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.

S.No Shipping Bills Nos Date of Let Export Description of product FOB value (in rupees)

(Signature and Stamp/ Seal of the Signatory)

(Chartered Accountant/ Cost & Works Accountant)

Name of the Signatory:

Place: Address:
Date: Membership No:

If any of the documents of record mentioned in serial number (i) have not been maintained/ furnished, examined or
verified, they may please be specified below:-

1.

2.

Note: Each page of this annexure is to be signed by the Chartered Accountant / Cost & Works Accountant with his registration
number.
 GUIDELINES FOR APPLICANTS
[ Please see paragraph 4 A.1 and 4A.28 of HBP v1 ]

1. Two copies of the application must be submitted unless otherwise mentioned.

2. Each individual page of the application has to be signed by the applicant.
3. RCMC details need not be given if the same has already given at the time obtaining IEC.
4. Application must be accompanied by documents as per details given below:

a. Bank Receipt (in duplicate)/Demand Draft evidencing payment of application fee in terms of Appendix
21B.
b. Bank certificate of export and realisation in the format given in Appendix 22A evidencing realisation of
exports proceeds/sales proceeds.
c. Export Promotion (EP) copy of Shipping Bill(s) in Original. (Photocopy of the EP copy of
Shipping Bill duly endorsed may be returned for utilization/re-import purposes when the exports are
made on consignment basis).
d. Customs attested invoice.
e. In case of application for Replenishment Authorisation under paragraph 4A.28 of this Handbook, an
applicant will be required to submit documents as given at S.No.1 above and Statement of Exports
made during the preceding licensing year duly certified by Chartered Accountant / Cost & Works
Accountant in the format given in Annexure
to ANF 4I.