Appendix-10B(i) - Proforma of Certificate for issue of authorization for Repeat Orders of SCOMET item(s) - Foreign Trade - Handbook of Procedures, 2023

Appendix-10 B(i) (Please see Paragraph 10.09 of HBP) Proforma of Certificate for issue of authorization for Repeat Orders of SCOMET item(s) CERTIFICATE [To be submitted by the End User on its letterhead, duly signed in ink by authorised signatory and stamped] PART 1: DETAILS OF THE ENTITIES a) Name of Exporter ____________________________________________ b) Name of Buyer _____________________________________________ c) Buyer s Address _____________________________________ d) Name of Consignee ___________________________________ e) Consignee s Address ______________________ f) Name of End-User ______________________ g) End-User s Address ____________________________ h) Specific Location where the items will be used (if different from (g)) ______________ i) Name of intermediary, if any j) Intermediary s address PART 2: ITEMS a) Description of the item(s) b) Quantity/Weight Description of the item(s) (e.g. Name of Model, Class, Type, Serial Number for goods) (in case of chemicals Purity/Concentration, IUPAC Name CAS Number) Quantity/Weight (Number / Kg. / MT) b) Purchase Order Number Date _____________________ c) Annual Operating Capacity _____________________ d) Shipment received in the year . _____________________ e) Current request in the year .. _____________________ f) Cumulative request till date .. _____________________ PART 3: DECLARATION a) The product and quantity, as indicated in PART 2 above, commensurate with installed annual operational capacity of our plant/ manufacturing unit [calculated calendar year wise (Jan. - Dec.)] and shall not be used for any purpose other than the purpose(s) stated in the end use statement given by us. b) That the cumulative quantity being imported by us during the year does not exceed the annual operational capacity of our plant/ manufacturing unit in respect of the relevant product, c) I/We also certify that all the facts contained in this certificate are true and correct to the best of my / our knowledge and belief and that I/we do not know of any additional facts that are inconsistent with this certificate. PART 4: SPECIFIC DETAILS OF AUTHORIZED SIGNATORY (mandatory): Signature Date : a. Name (in capital letters only): _____________________________ b. Designation: ______________ c. Complete office address (with room No. area, city, district, state, country) : _______ d. Pin/Zip/Postal Code : ___________ e. Telephone number (with ISD code): __________ or f. Mobile No. : _________ Fax No with ISD Code. : ___________(if any) g. Primary Email: ___________