2.

(i)

Address of the applicant. (Registered Office in case of limited companies, and the head  office  for others)

:

______________

(ii)

Name address of the branches, if any

:

______________

(iii)

Name and address of the factory.

:

______________

3.

(i)

IEC number

Date of issue

Issuing authority

:

________________

________________

________________

(ii)

Date of establishment

:

________________

4

If the registration is required as a manufacturer exporter SSI Registration Industrial Licence/IEM

:

No. _____________

Date ____________

  Issuing Authority: ______   

Others (specify)       

:

______________

5.

EH/TH/STH/SSTH/SHE/ISEH/ISSEH/ISSEH certificate number

:

Valid upto ______

6.

Details of Directors/Partners/Proprietor/Karta to be 
given in the following manner

(1)

(a)         Name 

:

_______________

(b)         Father's Name

:

_______________

(c) Residential address

:

_______________

_______________

_______________

(d) Telephone No. 

:

(2)

(a)         _________

(b)         _________

(c)         _________

(d)         _________

(3)

(a)         ________

(b)         ________

(c)         ________

(d)         ________

(4)

(a)         __________

(b)         __________

(c)         __________

(d)         __________

(4)

(a)         ___________

(b)         ___________

(c)         ___________

(d)         ___________

7.

(a)

Name of export product(s) or its category for which registration is required

:

________________

(b)

Main line of business of applicant

:

 ________________

8.

I/We hereby solemnly declare that the above stated information is  true and correct. I/We undertake, without any reservation, to:

(a)

abide  by  the terms  of  the  registration certificate granted to us on all our exports;

(b)

agree to abide by any code of conduct that may be prescribed;

(c)

agree to abide by export floor price condition that may be stipulated  by the  Registering Authority;

(d)

Furnish without fail monthly returns of exports including NIL returns to the Registering authority by 15th day of the months following the quarter.

9.

We further understand that our registration is liable to be canceled in the event of breach of any of the undertakings mentioned above.

10.

We/ I solemnly declare that we have applied to the Export Promotion Council which pertains to our main line of business. In case we have applied to any 
other council, the application has been made within the purview of the provisions of para 3.12 and 3.12.1 of the Handbook of Procedures (Vol 1).

Name

_________________

Address

_________________

Designation

_________________

Tele No:

_________________

Fax No:

_________________

E.Mail Address:

_________________

Residential address:

_________________

_________________

_________________

_________________

Place _______________                        

Date _______________