APPENDIX 19C - PROFORMA FOR FURNISHING OF QUARTERLY EXPORT RETURNS - Foreign Trade Procedure (RE - 2012) / 2009-14 (From 5-6-2012 to 31-3-2015)

APPENDIX 19 C PROFORMA FOR FURNISHING OF QUARTERLY EXPORT RETURNS 1. Name of the firm/company : .. 2. IEC number : .. 3. Details of exports: Period Item(s) Quantity, if applicable Country(s) of export (item wise) Value of export during the period (in Rs.) Cumulative exports (1.4.2005 onwards) (in Rs.) [1] [2] [3] [4] [5] [6] Cumulative exports (in words) : ............................................................................................................................................................................ DECLARATION I/We hereby declare that the above statements are true and correct to the best of my/our knowledge and belief. Signature Name Official Address Seal/Stamp