1[Annexure-A

[see clause (b) of sub-rule (1) of rule 18]

Minimum Required Information

 

  1. Name and Address of the producer/exporter/manufacturer:
  2. Registration Number:
  3. Country of origin:

All cost and price figures are to be shown in U.S. dollars ($) / national currency of the exporting Party

  1. Export Product-wise general information:

S. No.

Description of the good to be exported

Model/Brand

HS code

FOB/Ex Works

value (please specify)

 

 

 

 

 

 

  1. Good - wise cost breakup information (to be furnished for each good listed in Para 4 above):

A

B

C

D

E

F

G

H

I

J

K

L

Sl. no. and description of the exported good  

Compon ent/Input /materi als/parts/produce-wise break-up

Descripti on of component, materials, inputs, parts or produce

Quanti ty and

Unit

Unit CIF Value

Total CIF Value = (Quantity x Unit value)

HS Code (at ix digit level)

Supplier’s name and address

Country of Origin of the component, materials, inputs, parts or produce

Total value of non- originating Material

Labour cost

Other over heads costs

Profit

 

 

 

 

 

 

 

 

 

 

 

 

In column H, the entry shall be made to indicate the Country of Origin in terms of the Rules of Origin as one of the following:  

    1. India;
    2. United Arab Emirates; or
    3. non-originating materials.

6. Calculation (Complete one)

    1. Value of non-originating materials used in production as a percentage of FOB value or Ex-Works price; or
    2. Value of originating materials as a percentage of FOB value / Ex-Works price.  

7.  Description of the manufacturing process:

 

DECLARATION

I declare that the information provided by me as above is true and correct.

I will permit, as and when required, inspection of our factory/product and undertake to maintain up-to-date costing records.

Signature:  

Name:  

Title/Designation:

 

 

FOR OFFICIAL USE

The   particulars   given   above   have   been   checked, verified   by   the   records maintained by the applicant and found to be correct. On the strength of this evidence, the applicant is eligible to claim that the products have originated from ____________ as shown in serial number 3 above in terms of the provisions of Rules of Origin of the Agreement.

 

Place and Date:

Signature and Name of the Competent Authority with Official Seal (can be applied electronically) ]

 

 

 

 

 

 

Notes:

1. Inserted by the Notification No. 39/2022-Customs (N.T.) dated 30.04.2022.