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APPLICATION FORM FOR STATUS HOLDER CERTIFICATE

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..... o which the application is submitted 3. Category of Status applied for: please tick) (√) a) One Star Export House b) Two Star Export House c) Three Star Export House d) Four Star Export House e) Five Star Export House Part B - Export Performance Details 4. Details of Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service from India during preceding three (two for Gems and Jewelry Sector) financial years and current year (i.e. year in which application is being filed). Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service from India Type of Exports in USD (FOB / FOR value / Foreign Exchange Earned) Current Year in USD (Specify Period) Previous Year 1 in USD Previ .....

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..... Business (in 100 word) : Upload: Product Brochure in PDF 7.2 Link of the Website: 7.3 : Email ID for Business Enquires: Part D - Skilling and Mentorship Obligation 9. Details to be provided by the Status Houses (2 star houses and above) as part of skilling and Mentorship Obligation mandated in Para 1.30 of FTP 2023 9.1 Details of the Intended Training to be taken up : Financial Year (For current and next 5 years) Duration of the training Program (In Weeks) District of the Training Program Likely number of Trainees intended be taken Likely Venue of the Training Start Date (Month in MM/YY) End Date (Month MM/YY) Email id of the Contact Person Remarks 9.2 Whether the status house will be including factory visits/warehouse visit .....

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..... /Partner(s)/ Proprietor/Karta/ Trustee in any other Company/ firm / entity which is on the Denied Entity List (DEL) of DGFT C. Neither the Registered Office of the company / Head Office of the firm / nor any of its Branch Office(s)/ Unit(s)/ Division(s) has been declared a defaulter and has otherwise been made ineligible for undertaking import / export under any of the provisions of the Policy; 2. I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, as amended from time to time, the Rules and Orders framed there under the Foreign Trade Policy and the Handbook of Procedures 3. I/We hereby certify that that particulars and statements made in this application are true and correct and nothi .....

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..... nt records of M/s ....... .............……………………………………………having IEC Number ......................................... for Financial year (s) ...................................................... and hereby certify that: 1. Following documents / records have been furnished by applicant firm / company and have been examined and verified by me / us namely:- a) Statutory documentations under Customs Act 1962 and GST Acts, Foreign Trade (Development & Regulation) Act 1992 as amended; b) Export Order / Contract, Shipping Bills, Bill of Lading (and / or Airways Bills / PP Receipts), Customs / Bank attested Invoices, Forward In .....

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..... for shipments during last three years (two years for Gems and Jewelry Sector) plus current year are not outstanding beyond prescribed period as permitted by RBI. 6. The statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service has been calculated as under: Statement of Exports / Deemed Exports / Foreign Exchange Earned by Supply of Service from India Type of Exports in USD (FOB / FOR value / Foreign Exchange Earned) Current Year in USD Previous Year 1 in USD Previous Year 2 in USD Previous Year 3 in USD (not applicable for Gems and Jewelry Sector) 1. Exports of goods without weightage 2. Exports of services without weightage (As per Format A) 3. Exports with Double weightage (As per Format B) 4. FOR val .....

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..... rvice (USD) Format B Certificate of Exports where Double Weightage has been claimed (Applicable only if the application is for One Star Export House) Note: A shipment can be included in one of categories indicated below only once. Sl.No. Category of Exports FOB/FOR/Foreign Exchange earned in USD in Current Year FOB/FOR/Foreign Exchange earned in USD in Previous Year 1 FOB/FOR/Foreign Exchange earned in USD in Previous Year 2 FOB/FOR/ Foreign Exchange earned in USD in Previous Year 3 (not applicable for Gems and Jewelry Sector) 1 Micro and Small Enterprises as defined in Micro, Small & Medium Enterprises Development (MSMED) Act 2006 2 Manufacturing units having ISO/BIS Certification 3 Units located in North Eastern States incl .....

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