ANF- 5C

ANF- 5C

(Application Form for Clubbing of EPCG Authorizations)
Please see para 5.27 of HBP
(Please see the guidelines before filing the application)

1.	Applicant Details
	a.	IEC Number	Branch Code
	b.	Name
	c.	Address

2.	Details of EPCG Authorizations to be clubbed
	Sl. No.	EPCG Authorization		Customs Notification No.	Product(s) to be exported/ Services to be rendered
		No.	Date
	1	2	3	4	5

Duty saved amount (in Rs.)	Duty saved utilized (in Rs.)	Specific EO endorsed on the Authorization (in US $)	Specific EO as per utilization (in US $)	EO Fulfilled (in US $)
6	7	8	9	10

3.	Details of EPCG Authorization after clubbing
	a.	Total duty saved/Notional duty saved on the imports (in Rs.)
	b.	Export Obligation imposed on the Authorization
		(i)	In Indian Rupees
		(ii)	In free foreign exchange
	c.	Average Export Obligation imposed (in Rs.)
	d.	Description of Export Product(s)/Service(s) to be rendered

Declaration/Undertaking

I/We hereby declare/certify that:

1. I/We have updated my/our profile in ANF -1.
2. The particulars and the statements made in this application are true and correct to the best of my/our knowledge and belief and nothing has been concealed or withheld therefrom. If anything is found incorrect or false, it will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.
3. None of the Partners(s)/Director(s)/ Trustee/ Karta/ Proprietor of the firm/company has come under the adverse notice of DGFT or is in the caution list of RBI.
4. None of the Partners(s)/Director(s)/ Trustee/ Karta/ Proprietor of the firm/company, as the case may be, is/are a Proprietor/Partner/Director/Karta/Trustee in any other firm/Company which has come under the adverse notice of DGFT or is in the caution list of RBI, to the best of my knowledge.
5. Neither the Registered Office of the company /Head Office of the firm nor any of its Branch Office(s)/Unit(s)/Division(s) has been declared a defaulter or has otherwise been made ineligible for undertaking import/export under any of the provisions of the Policy.
6. I have not exported items on the SCOMET list for which permission has not been taken.
7. I am authorized to verify and sign this declaration as per Paragraph 9.06 of the Foreign Trade Policy.

Place
Date

Signature of the Applicant
Name
Designation
Official Address
Telephone/Mobile
Residential Address
Email-id

Guidelines for Applicants

1. Only One copy of the application must be submitted unless otherwise mentioned.
2. Application must be accompanied by the EPCG Authorizations in original.