ANF 5A

APPLICATION FORM FOR EPCG AUTHORISATION ISSUE

{Please see guidelines (given at the end) before filing the application}
I. IEC Number

2. Applicant Details

i. Name
ii. Address

3. RCMC Details

i. RCMC Number
ii. Date of Issue and valid upto
iii. Issuing Authority
iv. Products for which registered

4. Type of Exporter (please tick)

i. Merchant Exporter
ii. Manufacturer Exporter
iii. Merchant cum Manufacturer - Exporter
iv. Service Provider - Exporter
v. Others( please specify)

5. Industrial Registration Details

i. SSI / IEM/LOI or IL Registration Number

ii. Date of Issue
iii. Issuing Authority
iv. Products for which registered

6. Drug Manufacturing license Details

i. Drug Manufacturing License Number

ii. Date of Issue
iii. Issuing Authority
iv. Products for which registered

7. Service Tax Registration Details ( In case of Service providers registered with Service Tax authorities)

i. Service Tax Registration Number

ii. Issuing Authority
iii. Services for which registered

8. Excise Details (For those registered with Central Excise Authority )

i. Excise Registration Nimber

ii. Date of Issue / Issuing Authority

9. Status House Details

i. EH / SEH /TH / STH / PTH

ii. Certificate Number
iii. Date of Issue and valid upto
iv. Issuing Authority

10. Application Fee Details

Amount (Rs)
Demand Draft/Bank Receipt/Electronic Fund Transfer No
Date of Issue
Name of the Bank and branch on which drawn

86
11. Sector Classification of Capital Goods sought to be imported under the Scheme (Please tick)
i. Industrial sector
ii. Agricultural sector
iii. Port sector
iv. Service sector
v. Retail sector
vi. Others

11A. whether imports made are also Project Imports as per Para 5.1B of Policy Yes / No

11B. whether imports made are under Technological Upgradation Scheme Yes / No
If yes, give following details:
Sr FOB FOB FOB Value / FOB fixed in freely %age of FOB Expiry date of FOB period
No Authorisation Authorisation duty saved convertible currency fulfilled
No Date
1 2 3 4 5 6 7

11C. Details of Freely Importable Capital Goods applied for import

S No Description of the ITC(HS) Code Nature of Capital Goods sought Primary Use of Capital Goods sought to be
items of import to be imported + imported ++

1 2 3 4 5

Technical Specifications/ Quantity CIF Value

Model No. etc
6 7 8

11D. Details of Restricted Capital Goods applied for import

S No Description of the items of ITC(HS) Nature of Capital Primary Use of Capital Goods sought to be imported ++
import Code Goods sought to
be imported +
1 2 3 4 5

Technical Specifications/ Quantity CIF Value

Model No. etc
6 7 8

11E. Total CIF value of CG to be imported:

+ - whether Capital Goods / Spares / Tools /Jigs / Fixtures / Dies / Moulds /spare Refractories / Catalyst/
++ - whether used for Pre Production activity/ Production activity/ Post Production activity/ For rendering Services
(From amongst col.11Cand 11D 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 cols.)

11F. In case the CG proposed to be imported is under restricted category following information with regard to the sponsoring
authority may be furnished ( To be furnished wherever applicable)
Ministry / Department recommending the case
Recommendation letter no. and date

11G (a). Port of Registration for purpose of imports

87
11G (b). Address of the Factory/Premises

11G (c). Supporting manufacturer details

In case the proposed CG sought to be imported are to be used by supporting manufacture, please furnish
i. Name of Supporting Manufacturer:
ii. Address of supporting manufacturer
iii. SSI / LOI / IL Regn. No. & Date of Supporting Manufacturer
iv. Product endorsed on SSI/IL/IEM: (of Supporting Manufacturer)
v. Excise Reg. No. and issuing authority (if applicable) (of supporting manufacturer)

12. Details of duty saved

Total effective Duty to be leived Duty saved in (%) CIF value of imports Duty saved in Rupees
Custom Duty on under the scheme / deemed imports in
items to (in %) Rs.
beimported/deemed
to be imported (in %)
+++
1 2 3 = 1-2 4 5

Note:
i. +++ in case of indigenous sourcing of CG , duty saved is to be calculated on notional custom duty saved on
FOR Value of CG as per para 5.7A of FTP
ii. In case of EPCG Authorization for projects as per para 5.1B of Policy, the basic customs duty would be
7.5%. wherever CVD is paid in cash and not subsequently cenveted, CVD would not be taken for
computation of net duty saved.

13. Whether any export obligation has been imposed in the Letter of Intent/Industrial Licence/Foreign Collaboration approval
Yes/No
I .If yes, please furnish details thereof including FOB fulfilled, if any
ii. In case of Service Provider, please furnish
a. Serial No of Appendix 36 under which classified
b. Whether registered with Service tax authorities Yes / No

14. Products to be exported/Services to be rendered

15A. Details of exports made in preceding 4 licensing years same and similar products (including exports against all pending
EPCG Authorisations)
Sl.No. Financial Year Amount of Export of Export Amount for Export Amount for Total
same product / similar product / alternate / other
services services product / services
1 2 3 4 5 6 =3+4+5
1.
2.
3.
4.
Total

15B. Export Channel Details

Sl.No. Financial Year Direct Exports Through Third party Through Group Total
By applicant firm Exports company
itself
1 2 3 4 5 6 = 3+4+5
1.
2.
3.
4.
Total (1+2+3+4)

88
15C. Details of Group Company Exports
1. Group company Name
2. Date of Incorporation
Sl.No. Financial Year Product Direct Exports Value of Group Total
Particulars Value Company Exports
through third party
1 2 3 4 5 6 = 4+5
1.
2.
3.
4.
Total

16. EPCG Authorisations already obtained till date.

S. EPCG Authorisation No Products to be RA which CIF Value / Duty Expiry Date Redemptio
No and Date exported/services issued saved (Rs) of E.O. n Date /
to be rendered Authorisation Period Remarks

1 2 3 4 5 6 7
(i) Redeemed cases
during the last 4 years
(year-wise)

Total:
(ii) Not redeemed cases

Total:

16 (Contd.)
Sl. EPCG Authorization Average EO Specific EO on CIF / Duty
No. Details & Date (over complete EOP) Saving Total EO
(over complete EOP)
Fixed Fulfilled Fixed Fulfilled Fixed Fulfilled
1 2 (as in 16) 8 9 10 11 12 = 8+10 13 = 9+11
(i) Redeemed EPCG
Authorization

Total (i)
(ii) Non-Redeemed
EPCG Authorization

Total (ii)
Grand Total (i + ii)

17A. Details of Export Obligation (Average and Specific):

Average Export Obligation to Total duty saved (Rs.) Specific Export Obligation to be Total Export Obligation imposed
be imposed (Rs) (as shown as per column no.5 at imposed (as a multiple of duty
in sr.no.15(A) [Total of Col sr.no.12. saved)
(3+4) of row (2+3+4)/3]
(Rs.) (USD) (Rs.) (USD)
Rs. USD
1 2 3 4 5 6 7

17B. Export obligation Period: (8 year/ 12 years) :

Note: For Premier Trading Houses, exercising option of average over 5 years, all the above details must be given for 2
more years.

89
 DECLARATION/UNDERTAKING

1. I / We hereby declare that 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 held there from and if found incorrect or false will
render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.
2. I / We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, the Rules
and Orders framed there under, the Foreign Trade Policy, the Handbook of Procedures and the ITC(HS)
Classification of Export & Import Items.
3. I / We hereby certify that none of the Proprietor / Partner(s) / Director(s) / Karta / Trustee of the firm / company, as
the case may be, is/are a Proprietor / Partner(s) / Director(s) / Karta / Trustee in any other firm / Company which has
come to the adverse notice of DGFT.
4. I / We hereby certify that neither the Registered Office/Head Office of the firm/company nor any of its Branch Office(s)
/ Unit(s) / Division(s) has been declared a defaulter and has otherwise been made ineligible for undertaking import /
export under any of the provisions of the Policy.
5. I / We hereby declare that I/we have perused the list of SCOMET items as contained in the Appendix 3 to the
Schedule 2 of the ITC (HS) Classifications of Export-Import Items, 2004-09 and that the item(s) exported / proposed
to be exported does not fall within this list and that I/ We agree to abide by the provisions of the Policy for export of
SCOMET items contained in the Foreign Trade Policy, Schedule 2 of ITC (HS) and the Handbook of Procedures
(Vol.1), irrespective of the scheme under which the item is exported / proposed to be exported.
6. I / We declare that no export proceeds are outstanding beyond the prescribed period as laid down by the RBI, or such
extended period for which RBI permission has been obtained.
7. I / We hereby declare that the capital goods/spares sought for import in the application are actually required for use at
pre production/production/post production stages for the export product(s) or for rendering services for fulfilment of
export obligation.
8. I / We hereby declare that in respect of goods for which nexus is not established at a later date, I / We shall pay to the
Government Customs duty saved together with 15% interest on such imported goods which are found having no
relation with product exported or service rendered.
9. I / We hereby declare that in case of import of refurbished/reconditioned spares, the refurbished/reconditioned spares
have a residual life which is not less than 80% of the life of the original spares.
10. I / We hereby declare that I / We do not come under the purview of Service Tax and therefore are not registered with
the Service Tax Cell of the jurisdictional Central Excise Authorities. (in case of Service Providers who are not covered
under service tax)
11. I / We hereby declare that I/We shall not exceed the SSI investment limit in plant and machinery after making imports
under the EPCG Authorisation. (applicable in cases of imports made by SSI sector)
12. I / We hereby declare that the import of capital goods shall be used for building and operating shopping malls/super
markets having a minimum covered area of 1000 sq meters. (Applicable in case of imports made by Retail sector).
13. I / We hereby declare that I/We have not made imports under the Technological Upgradation Scheme previously
before any Licensing authority and the present imports of Capital Goods to be made under this Scheme (for which
this application is made) are more than 10% of the my/our present investment in the plant and machinery. (applicable
in case of imports under EPCG Technological Upgradation Scheme)
14. I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 9.9 of the Policy.
(Note: Strike out the clause which is not applicable.)

Signature of the Applicant Place

Name Date
Designation
Official Address
Telephone
Residential Address
Email Address

90
 GUIDELINES FOR APPLICANTS

1. Two copies of the application must be submitted unless otherwise mentioned.

2. Each individual page of the application has to be signed by the applicant.
3. In case CG sought to be imported is under restricted category, a copy of this application shall be sent to EFC at DGFT
HQRS also. (In such cases no separate application fee shall be required to be submitted while sending the copy of the
application to Hqrs. EFC). Upon clearance by EFC, EPCG authorisation shall be issued by RA and will bear an
endorsement that EFC has approved issue of EPCG Authorisation for restricted CG.
4. Application must be accompanied by documents as per details given below:

(1) Bank Receipt / Demand Draft / EFT details evidencing payment of application fee in terms of Appendix
21B.
(2) Self certified copy of Drug Manufacturing License in case of export of Pharmaceutical product or self
certified copy of IEM/SSI Registration Number in case of other products or a self certified copy of Service
Tax Registration in case of Service Providers.
. (In case of Service Providers, who are not registered with Service Tax authorities and a declaration in this
regard has been submitted as a part of the application (declaration no.10) , service tax registration is not
required to be submitted. In such cases RCMC from EPC concerned will suffice).
(3) Certificate from a Chartered Engineer in the format given in Appendix 32A certifying:
a the end use/nexus of machinery sought for import under EPCG Scheme in the pre
production/production/post production activity of the exported goods/services (explaining the end
use of machinery in detail); and/or
b the essentiality of spare parts sought for import and its required quantity for existing machinery
manufacturing the goods to be exported/ machinery sought for import; and/or
c complete usage of equipments/goods sought for import under the EPCG Scheme for supply of
service to overseas customers/ service consumers of any other country in India to earn free
foreign exchange/supply of service in India relating to export paid in free foreign exchange.
(4) Statement of exports made/services rendered by the applicant firm during the preceding three licensing
years duly certified by a Chartered Accountant / Cost and Works Accountant in the format given in
Appendix 26 as applicable.
a. In case of import of spares for existing plant and machinery, a list of plant/machinery imported
and already installed in the factory/premises of the applicant firm/supporting manufacturer for
which the spares are required, duly certified by a Chartered Engineer or jurisdictional Central
Excise authority
b. In case of EPCG applications made by EOU/SEZ units, a self certified copy of the `No Objection
Certificate from the Development Commissioner concerned showing the details of the capital
goods imported/indigenously procured by the applicant firm, its value at the time of
import/sourcing and the depreciated value for the purpose of assessment of duty under the
Scheme is to be submitted.
(5) Copy of previous EPCG Authorisation (in case application is made under EPCG Technological Upgradation
Scheme).
(6) In case of import of restricted capital goods under ITC(HS) a self certified copy of the recommendation
letter by the Sponsoring authority.( To be enclosed in case the same has already been obtained)

5. For example, if the application is in Financial Year 2008-09, then details may be given for 2004-05 and onwards.

91