APPENDIX-2M

Form of Self Declaration for obtaining Duplicate Copy of

freely transferable Licences / Authorisations which are lost or misplaced

(as per para 2.23 and 2.24 of HBP)

To

The DGFT Regional authority/ DGFT(HQ)

……

I/We hereby solemnly affirm and declare that customs purpose copy/exchange purpose copy/both the copies of Licence No. / Authorisation No.        dated       issued to me/us have been lost/ misplaced, without having been registered with any Customs House / after having been registered with        (Customs House) and not utilised at all/ utilised partly.

The total amount for which the Licence / Authorisation was issued is Rs. (figure and words       ) and USD (figure in words)……….. the total amount for which the duplicate is now required is to cover the balance of Rs.    .and USD (figure in words)

…………

The said Licence / Authorisation has not been cancelled, pledged, transferred, or handed over by me/us or on my behalf to, any other party for any purpose/consideration whatsoever.

I/We request to cancel the original Licence / Authorisation in lieu of which the duplicate copy has been applied for by me/us.

I/We agree and undertake to return the original Licence / Authorisation, if traced later, to the issuing authority for record.

Place: Signature of the Applicant

Date: Name

Designation Official Address Telephone Residential Address Email Address

Documents to be enclosed with the application form

As per para 2.24 duplicate copy of freely transferable Authorisation may be issued against an application accompanied with following documents:

1. An application with fee equivalent to 10% of duty saved or duty credit (of unutilized balance).

2. A copy of FIR reporting loss.

3. Self declaration to indemnify revenue loss, which may be caused on account of issue of such duplicate.