APPENDIX 11A - DATA SHEET FOR ADVANCE LICENCE APPLICATION ON SELF DECLARATION UNDER PARA 4.4.2 & 4.7 OF HANDBOOK (Vol.I) - Foreign Trade Procedure (RE - 2012) / 2009-14 (From 5-6-2012 to 31-3-2015)

1 [APPENDIX 11A DATA SHEET FOR ADVANCE AUTHORISATION APPLICATION ON SELF DECLARATION UNDER PARA 4.4.2 4.7 OF HBP v 1. (Please see para 4.4.2 4.7 of HBP v 1.) 1. Details of Items required for manufacture of one Unit of Export Product: (a) Imported inputs: S.No. Required import item Quantity required per unit of resultant product Purpose of requirement * Wastage claimed (%age) on net content basis. Recoverable wastage/by product Description Technical Characteristics ITC(HS) Code Name Quantity value * Purpose of requirement should be indicated against each item whether the same is required as raw material, components, consumables solvents, catalysts, packing material etc. (b) Indigenous inputs S.No. Required import item Quantity required per unit of resultant product Purpose of requirement * Wastage claimed (%age) on net content basis. Recoverable wastage/by product Description Technical Characteristics ITC(HS) Code Name Quantity value 2. Production and consumption data of the manufacturer/supporting manufacturer (of preceding three licensing years duly certified by the Chartered Accountant/Cost and Works Accountant/Jurisdictional Central Excise Authority*): *In case there is no past production, the Jurisdictional Central Excise Authority shall certify the production and consumption data on the basis of production batch sheets and for this purpose the firm shall maintain separate record of batch data for inputs consumed in the manufacture of the export product. Year Total production of the resultant product Quantity of different Items consumed Quantity consumed/unit production (1) (2) (3) (4) 3. Particulars of the authorisations (erstwhile licences) obtained in the past and ratified by Norms Committee (NC) (with or without modification) for the same export product covered under this application. S.No. Authorisation No Date Description of export product Description of import items Import item qty per unit of export product (as applied for) Import item qty per unit of export product (as approved by NC while ratifying licence) NC meeting No Date when approved (1) (2) (3) (4) (5) (6) (7) 4. Please furnish technical details as per Appendix-33 depending upon the resultant product. Please confirm. 5. a) FOB value of exports in the preceding licensing years : b) CIF value of authorisations already obtained under paragraph 4.7 : c) Balance entitlement as per paragraph 4.7.1. : Signature of the Applicant.................................. Name in Block letters................ Designation............................... Address.................................... Place: ............. Date: ............. .] ----------------------------------------------- Notes:- 1. Substituted vide Public Notice No. 3/(RE: 2010)/2009-2014, Dated 23/08/2010 , before it was read as:- APPENDIX 11A DATA SHEET FOR ADVANCE AUTHORISATION APPLICATION ON SELF DECLARATION UNDER PARA 4.4.2 4.7 OF HBP (v 1) 1. Details of Items required for manufacture of one Unit of Export Product: (a) Imported inputs: S.No. Required import item Quantity required per unit of resultant product Purpose of requirement * Wastage claimed (%age) on net content basis. Recoverable wastage/by product Description Technical Characteristics ITC(HS) Code Name Quantity value * Purpose of requirement should be indicated against each item whether the same is required as raw material, components, consumables solvents, catalysts, packing material etc. (b) Indigenous inputs S.No. Required import item Quantity required per unit of resultant product Purpose of requirement * Wastage claimed (%age) on net content basis. Recoverable wastage/by product Description Technical Characteristics ITC(HS) Code Name Quantity value 2. Production and consumption data of the manufacturer/supporting manufacturer (of preceding three licensing years duly certified by the Chartered Accountant/Cost and Works Accountant/Jurisdictional Central Excise Authority*): *In case there is no past production, the Jurisdictional Central Excise Authority shall certify the production and consumption data on the basis of production batch sheets and for this purpose the firm shall maintain separate record of batch data for inputs consumed in the manufacture of the export product. Year Total production of the resultant product Quantity of different Items consumed Quantity consumed/unit production (1) (2) (3) (4) 3. Particulars of the authorisations (erstwhile licences) obtained in the past and ratified by Norms Committee (NC) (with or without modification) for the same export product covered under this application. S.No. Authorisation No Date Description of export product Description of import items Import item qty. per unit of export product (as applied for) Import item qty. per unit of export product (as approved by NC while ratifying licence) NC meeting No Date when approved (1) (2) (3) (4) (5) (6) (7) 4. Please furnish technical details as per Annexure-I of Appendix-10 depending upon the resultant product. Please confirm. 5. a) FOB value of exports in the preceding licensing years : b) CIF value of authorisations already obtained under paragraph 4.7 in the current financial year CHARTERED ENGINEER CERTIFICATE I have examined the applicant company s import requirements of raw materials, components etc with regard to their technical description/ specification and the quantity against each item of import and having regard to proper technical norms of consumption and after technical scrutiny of relevant designs and drawings, I hereby certify that they are correct in all respects and are actually required for the execution of the export/supply contracts for ......................... The list of Items covers------------------------pages and contains---------------------------items for a total value of Rs._____________ (in free foreign exchange-------------------) Signature.................................. Name in Block letters................ Designation............................... Address.................................... Place: ............. Name and Address of the Institution under which Chartered : .................................. Date: .............. Ref No. and date of Corporate Membership : ..................................