APPENDIX 11A

DATA SHEET FOR ADVANCE AUTHORISATION APPLICATION

ON SELF DECLARATION UNDER PARA 4.4.2 & 4.7 OF HANDBOOK (Vol. I)

1. Details of Items required for manufacture of one Unit of Export Product:

(a) Imported inputs:
S.
No.

Required import item

Quantity
required
Description Technical ITC(HS) per unit of
Character- Code resultant
product
istics

Purpose of Wastage Recoverable wastage/by

requirement claimed
product
*
(%age) Name Quantity value
on net
content
basis.

Purpose of requirement should be indicated against each item whether the same is required as
raw material, components, consumables solvents, catalysts, packing material etc.

(b) Indigenous inputs

S.
No.

Required import item

Description

1.

Quantity
required
Technical ITC(HS) per unit of
resultant
Character- Code
product
istics

Purpose of Wastage Recoverable wastage/

requirement claimed
by product
*
(%age)
Name Quant- value
on net
ity
content
basis.

Production and consumption data of the manufacturer/supporting manufacturer (of preceding

three licensing years duly certified by the Chartered Accountant/Cost and Works
Accountant/Jurisdictional Central Excise Authority*):
*In case there is no past production, the Jurisdictional Central Excise Authority shall certify the
production and consumption data on the basis of production batch sheets and for this purpose the
firm shall maintain separate record of batch data for inputs consumed in the manufacture of the
export product.

Year

(1)

Total production of the resultant

product
(2)

Quantity of different Items

consumed
(3)

Quantity
consumed/unit
production
(4)

3.

Particulars of the Authorisations obtained in the past and ratified by Norms Committee (with or
without modification) for the same export product covered under this application.

S.No.

Authorisation
No & Date

Description of
export product

Description of
import items

Import item
qty per unit of
export
product (as
applied for)

(2)

(3)

(4)

(5)

(1)

Import item
qty per unit of
export
product (as
approved by
Norms
Committee
while ratifying
Authorisation)
(6)

Norms
Committee
meeting No
& Date
when
approved

(7)

4.

Please furnish technical details as per Annexure-I of Appendix-10 depending upon the
resultant product. Please confirm.

5.

a) FOB value of exports in the preceding

licensing years

b) CIF value of Authorisations already

obtained under paragraph 4.7:

c) Balance entitlement as per paragraph 4.71.

CHARTERED ENGINEER CERTIFICATE

I have examined the applicant company's import requirements of raw materials, components etc with
regard to their technical description/ specification and the quantity against each item of import and
having regard to proper technical norms of consumption and after technical scrutiny of relevant
designs and drawings, I hereby certify that they are correct in all respects and are actually required for
the execution of the export/supply contracts for .........................
The list of Items covers _________ pages and contains __________ items for a total value of
Rs._____________ (in free foreign exchange __________ )
Signature..................................
Name in Block letters................
Designation...............................
Address....................................
Place: .............

Name and Address of the Institution under

which Chartered

: ..................................

Date: ..............

Ref No. and date of Corporate Membership

: ..................................