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ANNEXURE - A
DECLARATION FORM FOR EXPORT OF GOODS
Master Details1.CHA License Number:2. CHA Name:3.IEC Code Number: 4. Exporters Name:5.Exporter Address:6.Exporter Type:[P] Private [G] Government 7.Merchant/Manufacturer:[R] Merchant [F] Manufacturer 8.Consignee Name:9.Consignee Address:10.Consignee Country:11.Port of Destination:12.Country of Final Destination:13.State of Origin of Exported Goods:14.SEZ/ICD Code:15Authorized Dealer (AD) Code:16.RBI Waiver Number:17.RBI Waiver Date:
18.Annexure C Parameter:Yes No
19. Annexure C Particulars (Only to be filled for Customs Location)
(a) Master Airway (b) Airline Name: Bill of Number:(c) Total No. of Packets in MAWB:(d) HAWB Number:
(e) Factory Stuffed(f) Seal No.: (Y/N):
(g) Agency:(h) Marks & Nos:
(i) Sample(j) Total No. of Packages: Accompanied Y/N):
(k) No. of Loose Packets:(l) Gross Weight:
(m) Net Weight:(n) Unit of Measurement:
(o) Packing Details:
Sr.No.Packet NumbersType of packetsFromTo
(1) (2)
(3)(4)
20. Annexure C Particulars (Only to be filled for ICD/CFS & Sea Customs Location)
(a) Factory Stuffed(Y/N):(b) Sample Accompanied(Y/N):(c) Nature of Cargo:(d) Marks & Number:
(e) Total No. of Packages:(f ) No. of Loose Packets:(g) No. of Containers:
(h) Gross Weight:(i) Net Weight:(j) Unit of Measurements:
(k) Container Details (only for Factory Stuffed containers)
Container NumberSizeExcise Seal NumberSeal DateNumber of packets stuffed(1)
(2)(3)(4)(5)
(l) Packing Details
Sr.No.Packing NumberType of Packets
FromTo(1)
(2)(3)(4)
Rotation Number:*(m)
Rotation Date: (n)
* Only for Sea Customs locations.
Details of Invoice:21. Invoice Number:22. Date:23. Nature of payment: [LC] Letter of Credit [DP] Direct Payment
[DA] Delivery against Acceptance [AP] Advance Payment
[NA] Not Applicable 24.Period of Payment as per contact (in Days): 25.Contract Number:26.Whether Consignee and Buyer Same:Yes No 27If No, Name & Address of Buyer:28Invoice Currency: [Enter Exchange Rate Particulars in case of Non- Standard Currency at point 27] 29Nature of Contract: FOB CIF CF CI
30Charges:ParticularsRateCurrencyAmountCommissionDiscount on FOB RatePacking & Misc. ChargesOther Deductions FreightInsuranceWhether the Unit Price includesFreight - [F] Insurance [I] Freight & Insurance - [B]
None - [N]31.Exchange Rate Details for Non-Standard Currency:
Currency Code/NameUnit in RupeesExchange RateBank NameCertificate NumberCertificate Date123456
32. Item Wise Details (To be provided for each invoice separately)
Item Sr. No.RITC CodeDescription of GoodsAccessories, if anyQuantityAccounting UnitItem RateNo. of UnitsAccounting Unit for RatePresent Market ValueScheme Code Category if NFEI ExportsWhether Third Party Export (Y/N) *(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)* Only for Scheme Codes involving DBK and DEBP. For other Scheme Codes (DEEC, EPCG, Job Work, DFRC), the system would determine the third party export automatically.
33. Drawback Particulars:
Invoice Sr. No.DBK Serial NumberDuty Drawback Details DBK Serial NumberQuantityRaw material DetailsRaw Material Serial NumberRaw Material Quantity(1)(2)(3)(4)(5)(6)
34. DEEC/EPCG Licenses Particulars:
Invoice Serial NumberItem Serial NumberDEEC/EPCG Licenses ParticularsRegistration NumberSerial Number in Part (E)Serial Number in part (C)QuantityAccounting UnitWhether Indigenous/Imported(1)(2)(3)(4)(5)(6)(7)(8)
34. DFRC Licenses Particulars:
Invoice Serial NumberItem Serial NumberDEEC/EPCG Licenses ParticularsRegistration NumberStandard Input / Output Group CodeStandard Input / Output Serial NumberStandard Input / Output Norm Serial NumberQuantityAccounting UnitWhether Indigenous/Imported(1)(2)(3)(4)(5)(6)(7)(8)(9)
35. Post Export DEPB Particulars:
Invoice Serial NumberItem Serial NumberDEPB DetailsGroup CodeItem CodeQuantityAccounting UnitParent DEPB DetailsGroup CodeItem CodeQuantityAccounting Unit(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)
36. Job Work Particulars:
Invoice Serial NumberItem Serial NumberBill of Entry ParticularsNotification NumberB/E NumberDateB/E Invoice Serial NumberActual Invoice NumberItem Serial Number in invoicePort Code, where importedQuantityUnit of Measurement(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)
37. Annexure C1 Particulars (Applicable to EOU/SEZ):
Invoice Serial NumberIEC CodeAnnexure C1 DetailsExamination DateDivisionCommn.RangeExamination Officer NameExamination Officer DesignationSupervisor Officer NameSupervisor Officer DesignationSeal Numbers Affixed on Packages. (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)
38. Re-Export Particulars:
S. No.Re-Export Particulars1Invoice Serial No. of S/B2Item Serial No. of S/B3B/E Number4B/E Date5Invoice No. of B/E 6Item Serial No. of B/E 7Port Code8Item Description As per B/E Invoice 9Quantity Imported 10Unit of Measurement11Assessable Value in (Rs)12Total Duty Paid13Duty Payment Date14Quantity Exported15Technical Details16Other Identifying Parameters17Whether against export Obligation (Y/N)18Export Obligation Notification No.19Drawback Amount Claimed20Whether Item Un-used (Y/N)
21Commissioner Permission (Y/N)22Board Order Number23Board Order Date24Whether CENVAT Availed (Y/N)25Whether CENVAT Reversed (Y/N)
39. Cess Particulars (If applicable):
Invoice Serial NumberItem Serial NumberCess Serial NumberCess Quantity(1)(2)(3)(4)
40. CENVAT Particulars:
Invoice NumberItem Serial NumberCertificate NumberCertificate DateCentral Excise Office CodeAssessee CodeValid Upto(1)(2)(3)(4)(5)(6)(7)
41. Third Party Exports:
Invoice NumberItem Serial NumberIE CodeName of the ManufacturerBank Serial Number*Address(1)(2)(3)(4)(5)(6)* Only if the third party is also a regular exporter.
42. ARE 1 Particulars:
Invoice Serial NumberItems Serial NumberARE-1 ParticularsARE-1 NumberARE-1 DateCommissionerateDivisionRangeRemarks(1)(2)(3)(4)(5)(6)(7)(8)
43. Documents & Releasing Agencies Particulars:
Document Type Document DescriptionInvoice NumberItem NumberAgency CodeAgency NameDocument Name(1)(2)(3)(4)(5)(6)(7)
44. Quota Allocation Particulars
Invoice
Sl. No.Item
Sl. No.AgencyAllocation Serial Number
Country Code/Year/Region Code/Serial Number/
Category/ Quota or Non Quota Country/Token No.)Expiry Date(1)(2)(3)(4)(5)
DECLARATION
I/We declare that the particulars given herein above are true, correct and complete. I/We enclose herewith the copies of the following documents*.
SDF Declaration
DEEC Declaration
Invoice
Quota/Inspection Certificates
Others (Specify)
Name of the Exporter: Name of CHA:DesignationDesignationID Card Number
* To be submitted with the exports goods in the warehouses.
Date: ..
Signature:
INSTRUCTIONS:
All entries should be made in CAPITAL letters.
Photocopies of the Invoices has to be attached separately with declaration form for data entry.
APPENDIX-1
FORM SDF
Shipping Bill No. .. Date: ..
Declaration under Foreign Exchange Management Act, 1999:
1. I/We hereby declare that I/We am/are the SELLER/CONSIGNOR of the goods in respect of which this declaration is made and that the particulars given in the Shipping Bill No. .. Dated ..are true and that-
a)* The value as contracted with the buyer is same as the full export value declared in the above shipping bill.
b)* The full export value of the goods is not ascertainable at the time of export and that the value declared is that which I/We, having regard to the prevailing market conditions, expect to receive on the sale of goods in the overseas market.
2. I/We undertake that I/We will deliver to the bank named herein the foreign exchange representing the full export value of the goods on or before @ .. in the manner prescribed in Rule 9 of the Foreign Exchange Management Rules, 1999.
3. I/We further declare that I/We am/are resident in India and I/We have a place of business in India.
4 I/We * am/are OR am/are not in Caution List of the Reserve Bank of India.
Date
Signature of (Exporter)
Name ..
@ State appropriate date of delivery which must be the due date for payment or within one year from the date of shipment, whichever is earlier, but for the exports to warehouses established outside India with permission of the Reserve Bank, the date of delivery must be within fifteen months.
* (Strike out whichever is not applicable)
PAGE 14
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