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    Application Form for Exporter Profile

    APPENDIX – 2

    PROFILLE OF EXPORTER / IMPORTER

    FOR OFFICIAL USE

    File No :Date

    Note : To be submitted once along with the first application and to be submitted subsequently only in case of any change in the information already submitted.

    RLAs to enter this information in the computer so as to dispense with the need of repetitive declaration
    APPENDIX - 2  
       
    Name of the applicant :
    		__________________
       
    Address of the applicant :
    		__________________
       
    (Registered Office in case of limited companies, and Head Office for others)
    		  
      Tele No : __________________
      Fax No. : __________________
      Email address : __________________
    Date of establishment of business/ factory in India
    __ __ __ __ __ __ __ __
        d   d   m   m   y   y    y   y
    IEC No __________________ Date of Issue__________________

    (not applicable for application for IEC)
    Issuing Authority __________________
    Please tick the appropriate column.
    (1) Manufacturer Exporter :
    		 [  ]
    (2) Merchant Exporter :
    		 [  ]
    (3) Service provider :
    		 [  ]
    (4) Merchant cum Manufacturer :
    		 [  ]
    (5) Trust :
    		 [  ]
    (6) Others (please specify) :
    		 [  ]
       
    Status Code

    (please see S.No.7(b) of Appendix-1 of general instructions)

    Relevant Certificate
      No : __________________
      Issuing Date : __________________
      Valid upto : __________________
       
    Category of Manufacturing Licence
    Number
    Date
    Issuring Authority

    SSI Registration
    		 __________________
    		 __________________
    		 __________________
           
    Industrial Licence / IEM __________________ __________________ __________________
           
    Others (Specify) __________________ __________________ __________________

    Nature of the coneern :  [  ]

    (please see S.No.7 ( c) of Appendix-1 of general instructions)
    Details of the main Banker Name of the Bank __________________
       
    And Bank Account Account No __________________
       
      Type of Account __________________
       
      Address : __________________
                  __________________
                  __________________
       
    RCMC No __________________ Date of Issue __________________
       
    Valid up to __________________ Issuing Authority __________________
       

    Details of Proprietor/Partner(s)/Director(s)/Karta to be given in the following manner :
    (1) (a) Name :
    		__________________
       
    (b) Father's Name :
    		__________________
       
    ( c) Residential Address :
    		__________________
       
    (d) E-Mail address :
    		__________________
       
    (e) Telephone :
    		__________________
       
    (NOTE) : Attach extra sheet wherever required)