APPENDIX 19A - FORM OF APPLICATION FOR REGISTRATION CUM MEMBERSHIP (RCMC) WITH EXPORT PROMOTION COUNCILS - Foreign Trade Procedure (RE - 2012) / 2009-14 (From 5-6-2012 to 31-3-2015)

APPENDIX 19 A FORM OF APPLICATION FOR REGISTRATION CUM MEMBERSHIP (RCMC) WITH EXPORT PROMOTION COUNCILS To, The _______________________________ _______________________________ _______________________________ (Name and Address of the Council) Dear Sir, Kindly register us as Merchant/Manufacturer exporter of the export product(s) mentioned below. 2. (i) Address of the applicant. (Registered Office in case of limited companies, and the head office for others) : _____________________ (ii) Name address of the branches, if any : _____________________ (iii) Name and address of the factory. : _____________________ 3. (i) IEC number Date of issue Issuing authority : ____________________ (ii) Date of establishment : ____________________ 4 If the registration is required as a manufacturer exporter SSI Registration Industrial Licence/IEM : No. ________________________ Date _______________________ Issuing Authority: _____________ ___________________________ Others (specify) : ___________________________ 5. EH/TH/STH/SSTH/SHE/ISEH/ISSEH/ISSEH certificate number : Valid upto __________________ 6. Details of Directors/Partners/Proprietor/Karta to be given in the following manner (1) Name : ____________________________ Father's Name : ____________________________ (c) Residential address : ____________________________ ____________________________ ____________________________ (d) Telephone No. : (2) _____________________ _____________________ _____________________ _____________________ (3) _______________________ ________________________ ________________________ ________________________ (4) _____________________ _____________________ _____________________ _____________________ (5) ________________________ ________________________ ________________________ ________________________ 7. (a) Name of export product(s) or its category for which registration is required : ____________________________ (b) Main line of business of applicant : 8. I/We hereby solemnly declare that the above stated information is true and correct. I/We undertake, without any reservation, to: (a) abide by the terms of the registration certificate granted to us on all our exports; (b) agree to abide by any code of conduct that may be prescribed; (c) agree to abide by export floor price condition that may be stipulated by the Registering Authority; (d) Furnish without fail monthly returns of exports including NIL returns to the Registering authority by 15th day of the months following the quarter. 9. We further understand that our registration is liable to be canceled in the event of breach of any of the undertakings mentioned above. 10. We/ I solemnly declare that we have applied to the Export Promotion Council which pertains to our main line of business. In case we have applied to any other council, the application has been made within the purview of the provisions of para 2.63 of the Handbook of Procedures (Vol 1). Yours faithfully, (Signature) Name ___________________________. Address ___________________________. Designation ___________________________. Tele No: ___________________________. Fax No: ___________________________. E.Mail Address: ___________________________. Residential address: ___________________________. ___________________________. ___________________________. ___________________________. Place _______________ Date _______________ ---------------------------------------------------------------------- Documents to be enclosed with the application form: ---------------------------------------------------------------------- 1. A self certified copy of the IEC Number issued by the regional authority concerned.