Appendix 22 D

Certificate for Offsetting of Export Proceeds

1. Name and address of exporter

2. IEC number

3. E-Mail of the applicant

4 Specific mode of offsetting (please tick)	( √ )
i. Import Payables
ii. Equity Investment
iii. Loan Repayment
iv. Dividend Repayment
v. Others (Provide details)

5. Export Details

Invoice		Shipping bill against which offset has been done		Description of goods	Scheme under which offsetting undertaken	Amount offsetted (in free foreign exchange)	Date of offsetting
No.	Date	No.	Date
(1)	(2)	(3)	(4)	(7)	(5)	(6)	(7)

(Declaration/Undertaking to be given by the Applicant)

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 therefrom.

2. I/We full understand that any information furnished in the application if proved incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.

3. I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, the Rules and Orders framed thereunder, the Export and Import Policy, Handbook of Procedures and any other documents issued under the Policy.

4. I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 9.9 of the Policy.

5. I/we hereby certify that none of the Proprietor/ Partner(s)/ Director(s)/Karta of the firm or company is a Proprietor/ Partner(s)/ Director(s)/Karta of the firm/Company, which has come to the adverse notice of DGFT.

6. I/We certify that the RBI permission vide letter no.________ dated _______ has been obtained for the said offsetting of export proceeds realised under ________ scheme.

Name: ........................

Designation: .......................

Official Address: ........................

Tele.No.: ........................

Residential Address: ........................

........................

Place:

Date :

Annexure to Appendix 22 D

Certificate of Chartered Accountant/Cost and Works Accountant

(Note: This certificate is to be submitted in lieu of the Bank Certificate of Exports and Realisation)

(i) The following documents/ records have been furnished by the applicant and have been examined and verified by me/us namely:-

Export order/ Contract, shipping bills, Bill of Lading (and/ or Airways Bills/ Receipts). Customs/Bank attested Invoices,

(ii) I/We verify that the offsetting has been carried out with the specific consent of the Reserve Bank of India as contained in letter no.________ dated ______ and is in accordance with the rules/regulations in force.

(iii) It has been ensured that the information furnished is true and correct in all respect; no part of it is false or misleading and no relevant information has been concealed or withheld;

(iv) Neither I, nor any of my partners/director is a partner, director, or an employee of the above-named entity or its associated concerns;

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

(Signature and Stamp/Seal of the Signatory)

(Chartered Accountant/Cost & Works Accountant)

	Name of the Signatory	:
Place:	Full Address	:
Date:	Membership No.	:

Documents to be enclosed with this certificate

i) Specific permission of the Reserve Bank of India

ii) Letter from the parent company/buyer etc. indicating the proposal for offsetting of export proceeds.