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Application Form For Import Of Restricted Items

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..... IEC Number IEC Name Branch code Address City State Pin Code Mobile Number Email ID Industrial Registration No. (Udyam/IEM etc.) PAN Number CIN Number Name of the Nodal person Mobile Number of Nodal person .....

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..... l.No. Import licence Number Date of issue of Licence Country of origin Port of Registration for import ITC(HS) Code Quantity approved in Licence Quantity consumed Balance Quantity Unit of measurement Declare of sales/turnover of items (Imported/Indigenous) Sl.No. Year Total Total turnover of products whose licence applied for 1. 2. 3. .....

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..... otification No. 32 dated 14.09.2022 to be furnished In case of end product being a bulk drug or formulation, please furnish details: (i) Copy of relevant Drug Manufacturing Licence granted by the competent authority (ii) Production of the relevant end product in terms of quantity and value during last 3 years duly certified by CA (iii) Actual consumption of the restricted items applied for import during 3 years in terms of quantity and value duly certified by a CA In case of import of refurbished computer parts brief description of the import product and it usage please furnish details: .....

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..... 1. I/We hereby certify that: A. the entity for whom the application has been made have not been penalized under any of the following Acts (as amended from time to time): A. The Customs Act, 1962, B. The Central Excise Act, 1944 C. Foreign Trade (Development Regulation) Act 1992, as amended, and D. The foreign Exchange Management Act, 1999; E. The Conservation of Foreign Exchange, Prevention of Smuggling Activities Act, 1974 B. none of the Directors / Partners / Proprietor / Karta / Trustees of the company /firm /HUF/Trust, (as the case may be), is/are a Director(s) / Partner(s) / Proprietor / Karta / Trustee in any other Company/ firm / entity which is on the Denied Entity Lis .....

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