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Ref
NO. : |
|
Date
: |
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01. Name of the firm
with full address :
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IEC NO. : |
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02. Approval Letter No. & Date
: |
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03. EH/TH Certificate
:
No & Date |
|
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Valid upto : |
(Attach a self certified copy of the
certificate issued by DGFT) |
|
04. Whether SSI ? |
Yes/No.
(If yes, attach a self-certified copy of SSI
Registration Certificate) |
05. FOB value of exports during last three
financial years, year-wise |
(Rs. In
Crores)
2003-2004
2002-2003
2001-2002 |
06. Particulars of Events
|
|
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07. Date of actual Departure
from India :
|
(Please attach self certified photocopy of
passport duly highlighting date of departure).
|
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08. Date of actual
Arrival
from India :
|
(Please attach self certified photo copy of
passport duly highlighting date of arrival).
|
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09. Name and designation of the
person who attended the event :
|
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10. No. of proposal(s) already submitted in the
same financial year.
|
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11. Whether
national participation in the fair/exhibition organized by
ITPO, EPC etc.
|
Yes / No
|
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12. Whether
participation through ITPO, EPC etc.,
|
Yes / No
|
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13. Whether waiver certificate
taken from ITPO, EPC etc.
|
Yes / No / N.A.
|
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14. Details of
participations made with MDA assistance in the past same event.
|
|
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15. Weather assistance
availed from other Govt. Bodies/EPCs/Commodity
Boards/APEDA/MPEDA/ITPO etc. for the activity under
reference?
|
Yes / No.
(If yes, please give full details)
|
16. Expenditure incurred:
(a) Actual return airfare by economy excursion
class
(b) Actual expenditure incurred on stall,
decoration, water & electricity charges. |
Rs.
Rs.
(Please attach original air
ticket/jacket used during the journey along with
self certified photocopies of receipt, bank advice
etc. evidencing payment method). |
|
17. Amount Claimed :
|
Rs.
|
|
|
|
|
|
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Declaration I
solemnly declare that the particulars given in the
above statement are correct. I bound myself and the
company accountable and responsible for any
incorrect information given in the above statement
and shall immediately refund amount received on the
basis of wrong information provided in the above
statement.
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Signature :
|
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Name
:
|
|
|
|
Designation
:
|
|
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Office
Seal :
|
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Place
: |
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Date
: |
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