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Annex to 08-PN-06.05.2016

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Annex to 08-PN-06.05.2016
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    Annexure ANF- 5A   (Application Form for Issuance of EPCG /Post Export EPCG Authorization)  (Please see the guidelines before filling the application) 1. Application for Please tick () a. EPCG Scheme b. Post Export EPCG Scheme 2. IEC No. Branch Code Declaration: I/We have updated my/our profile in ANF -1. 3. Address of the factory/premises of the applican where the capital goods to be imported ar proposed to be installed 4. Excise Registration Details a. Excise Registration Number ( if registered with Central Excise) b. Date of registration c. Address of the urisdictional Central Excise Authority (To be given irrespective of whether registered/ not register   e with Central Excise) 5. Port of Registration (for the purpose of imports) 6. Application Fee Payment details a. Amount (in INR.) b. Mode of Payment (Bank Receipt/ Electronic Fund Transfer/Credit Card/Debit Card) c. Serial No. of Bank Receipt/EFT No./Credit Card/Debit Card details and Date of Payment    7. Service Tax Registration Details (in case of Service Provider registered with Service Tax Authorities) a. Service Tax Registration Number b. Date of registration c. Address of urisdictional Service Tax Authority d. Services for which registered 8. Sector Classification of Capital Goods sought to be imported under the Scheme (Please tick) a. Industrial Sector b. Agricultural Sector c. Service Sector d. Green Technology Sector e. Units in North Eastern Region/Sikkim/&K 9. Products to be exported/services to be rendered ITC(HS) Code/Service Code 10. Details of exports of same/similar product/services made in the preceding three licensing years (excluding exports which have been counted / are being counted for fulfilling specific EO in respect of EPCG Authorizations within valid EO Period) Sl. No. Financial Year Total FOB Value of exports/services rendered for the same/similar product/services (INR in Crores) 1 2 3  Total *Average export performance *If an applicant has been in existence for less than 3 years, the aggregate export will be divided by the number of years for which the company has been in existence and not by 3 years. 11. Details of EPCG Authorizations where EO is pending    Sl. No. Authorization No. and Date RA which issued the Authorization Value of duty saved/duty paid (in INR.) EO fixed on duty saved/duty paid (in freely convertible currency)/INR. Specific EO fulfilled Annual Average EO fixed (in INR.) Expiry date of EO period 12. Details of Capital Goods sought to be imported Sl. No. Description of the items of import ITC(HS) Code Nature of Capital Goods sought to be imported* Quantity Primary use of Capital Goods sought to be imported** * Whether Capital Goods/Spares/Tools/Jigs/Fixtures/Dies/Moulds/Spare refractories/Catalyst/Computer software systems (specify if any other) ** Whether used for Pre-production activity/Production activity/Post-production activity/for rendering services 13. Whether product to be imported is restricted for import Yes/No. (If yes, enclose copy of EFC approval fromDGFT Hqrs.) 14. Details of Restricted Capital Goods applied for import Sl. No. Description of the items of import ITC(HS) Code Nature of Capital Goods sought to be imported* Primary use of Capital Goods sought to be imported** * Whether Capital Goods/Spares/Tools/Jigs/Fixtures/Dies/Moulds/Spare refractories/Catalyst /computer software systems(specify if any other) ** Whether used for Pre-production activity/Production activity/Post-production activity/for rendering services (At Sl. No. 13 and 14  above, please fill up whichever is applicable. In case applicant desires to import both restricted and freely importable capital goods appropriate information should be given in both the columns).   15. Whether product to be exported is restricted for export Yes/No. (If yes, enclose copy of EFC approval fromDGFT Hqrs.) 16. Details of Duty  Total effective Customs duty on items to be imported (in %) CIF value of imports/ Indigenously procured capital goods (in INR.) Duty saved amount (in INR.)    1 2 3 Note: In case of indigenous sourcing of CG, duty saved is to be calculated on notional customs duty saved on FOR value of capital goods as per Para 5.07 of FTP. 17. Details of Duty in case of post-export EPCG duty credit scrip  Total effective Customs duty on items to be imported (in %) Basic Customs duty CIF value of imports/ Indigenously procured capital goods (in INR.) Duty paid (in INR.) 18. Details of Export Obligation imposed  Total duty saved/duty paid (INR) Specific Export Obligation to be imposed Average Export Obligation to be imposed INR US$ INR 19. Address of the factory/premises of the applicant or the supporting manufacturer where the capital goods to be imported are proposed to be installed 20. In case the proposed capital goods sought to be imported are to be used by the supporting manufacturer a. Name b. Address c. MSME/IEM/LOI/IL Registration No. and date d. Products endorsed on MSME/LOI/IL/IEM e. Excise Registration No. and issuing authority, (if applicable) 21. Postal address of the jurisdictional Central Excise Authority in whose jurisdiction factory/premises of the applicant/supporting manufacturer where the capital goods to be imported are proposed to be installed
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