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..... facturer: 2. Registration Number: 3. Country of origin: All cost and price figures are to be shown in US dollars ($) 4. Export Product-wise general information: S. No. Description of the product Model/Brand HS code FOB / ex-works value 5. Product -wise material cost information (to be furnished for each product listed in Para 4 above): A B C D E F G H Sl. no. Description of co .....

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..... __ DECLARATION I declare that the information provided by me as above is true and correct. I will permit, as and when required, inspection of our factory/products and undertake to maintain up to date costing records. Signature, Name and Designation of the signatory FOR OFFICIAL USE The particulars given above have been checked, verified by the records maintained by the applicant and found to .....

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