APPENDIX 15A - APPLICATION FOR CERTIFICATION OF EXPORT PERFORMANCE OF UNITS IN THE PHARMACEUTICAL AND BIOTECHNOLOGY SECTORS BY THE REGIONAL OFFICES OF THE DGFT AS PER CUSTOMS NOTIFICATION NO 21/2002 DATED 1.03.2002 AS AMENDED FROM TIME TO TIME - Foreign Trade Procedure (RE - 2012) / 2009-14 (From 5-6-2012 to 31-3-2015)

APPENDIX 15 A APPLICATION FOR CERTIFICATION OF EXPORT PERFORMANCE OF UNITS IN THE PHARMACEUTICAL AND BIOTECHNOLOGY SECTORS BY THE REGIONAL OFFICES OF THE DGFT AS PER CUSTOMS NOTIFICATION NO 21/2002 DATED 1.03.2002 AS AMENDED FROM TIME TO TIME 1. Name and Address of the Applicant 2. IEC Number 3. Details of exports and import entitlement: Preceding licensing year s physical exports (in Rs crores) Entitlement @ 25 % of the FOB value of physical exports Cumulative imports already undertaken under Customs Not 21/2002 (in Rs. crores) Balance import entitlement (in Rs. crores) (2) - (3) CIF Value of Import to be undertaken under this application (In Rs. crores) Balance entitlement of imports (4) - (5) 1) (2) (3) (4) (5) (6) Declaration/Undertaking by the Proprietor/Partner/Director a. We/I hereby declare that the said goods are imported for use in pharmaceutical and biotechnology sector and shall be used in the manufacture of commodities only. b. We/ I hereby undertake that the total value of goods imported during 2005-2006 under Customs Notification No 21/2002 will not exceed 25% of the FOB value of exports in the financial year 2004-2005. c. We/I hereby undertake that the imported goods would be installed in the factory of the importer within 6 months of the date of importation. These goods would not be transferred or sold for a period of 7 years from the date of installation. d. We/I hereby declare that the Research and Development wing of the unit which has undertaken these imports is registered with the Department of Science and Industrial Research in the Ministry of Science and Technology of the Government of India. e. We/I hereby declare that the above statements are true and correct and nothing has been concealed or held there from. We/I fully understand that any information furnished if proved incorrect or false will render us/me liable for penal action and other consequences as may be prescribed in the FTDR Act 1992 , Foreign Trade Regulation Rules, 1993 and Orders framed thereunder, and any other law in force. Name of the Proprietor/ Director (s)/ Partner (s) Signature of the Proprietor/Director(s)/ Partner(s) Designation Date: Place: CHARTERED ACCOUNTANTS CERTIFICATE This is to certify that the We/ I have verified the details furnished by the unit as at S.Nos 1 to 3 along with the Declaration/ Undertaking given by the Proprietor/ Partner/ Director of the unit(s) and find them to be true and correct. Chartered Accountant s Name CA Number Address VERIFICATION BY THE REGIONAL OFFICE OF THE DIRECTORATE GENERAL OF FOREIGN TRADE This is to verify that the details supplied by the firm in the said Appendix have been verified by the Chartered Accountant and are correct as per the records submitted by the Unit to this office. The certificate is issued for allowing duty free import of listed equipment given in List 27A of the Customs Notification 10/2002 dtd 21.02.2002 for a value of Rs ............... words and figures .................... subject to conditions mentioned in the aforesaid Customs Notification. Date: Place: Foreign Trade Development Officer Office of the Joint Director General of Foreign Trade, ...........