APPENDIX -4H

REGISTER FOR ACCOUNTING THE CONSUMPTION AND STOCKS OF DUTY FREE IMPORTED OR DOMESTICALLY PROCURED RAW MATERIALS, COMPONENTS ETC. ALLOWED UNDER ADVANCE AUTHORISATION / DFIA*

INPUTS ALLOWED IN THE AUTHORISATION(S)*** (ANY NO. OF AUTHORISATIONS CAN BE CLUBBED TOGETHER FOR THE PURPOSE OF ACCOUNTING OF INPUTS)

PRODUCT (S) EXPORTED UNDER THE AUTHORISATION(S)

EXCESS INPUTS, IF ANY ALLOWE D UNDER THE AUTHO RISATIO N(S).

(4 - 8)

IN CASE OF EXCESS AS IN COLUMN 9

REMARKS

Sl.

No

.

Authoriz ation No(s) with date (A No. of authoristi ons can be clubbed together for accounti ng purpose)

Inputs

Quantity

Product

Quantit y

Inputs Actually consumed for the exported product

Additional exports effected in proportion to excess inputs

Input quantity reduced proportionatel y in the authorization

Customs duty paid along with interest

Input s

Quantity (Including actual     wastage

incurred)

1

2

3

4

5

6

7

8

9

10

11

12

13

*In case of Post export replenishment, details of inputs used (whether duty paid or not) in the exported product has to be furnished.

**Applicable only in case either partial import or “NIL” import has been effected.

*** In case of transferable DFIA, information in the above format has to be furnished individual DFIA wise.

We declare that the aforesaid particulars are correct.

Place:

Date:

Official Seal/stamp

Signature of the Authorization holder:...........................................

Name in block letters:______________________

Designation:____________________

Full official address: Full Residential address:

CHARTERED ACCOUNTANT / COST ACCOUNTANT CERTIFICATE

I/We hereby confirm that I / We have examined the prescribed registers and also the relevant records of M/s.............................having IEC number...........and

PAN number.........................for the licensing period(s)............and hereby certify that the information furnished above is true and correct in all respects; no part of

it is false or misleading and no relevant information has been concealed or withheld;

I/We fully understand that any statement made in this certificate, if proved incorrect or false, will render me/us liable to face any penal action or other consequences as may be prescribed in law or otherwise warranted.

I/We further declare that neither I, nor any of my/ our partners is a partner, director, or an employee of the above-named entity, its Group companies or its associated concerns.

(Signature and Stamp/ Seal of the Signatory)

(Chartered Accountant/ Cost Accountant)

Name of the Signatory

Place:

Address:

Date:

Membership No:

Note: