BLISS BIOTECH PVT. LTD .

Mermaid – 1, Office -11, Sector -11, CBD Belapur, Navi Mumbai 400614
Tel . No. 022-22957754 , Fax : 022-27576276
Email : allwell2401@yahoo.com / biotechbliss@yahoo.com

To, Date.
The Jt.Director General of Foreign Trade,
New CGO Building,
New Marine Lines;
Mumbai 400 020.

DECLARATION

I/We hereby declare that no other Identity card application has been made for the same person.
Mr.Kalpak B Koli. By any other Company to the Joint DGFT. Mumbai Office on till date.

We hereby declare that this is our First/Second/Third application of Identity Card of our Company.

The following Identity Card details are submitted of our Company.

NAME DESIGNATION I CARD NO. DATE OF ISSUE. Validity

For Bliss Biotech Pvt Ltd

Director.

Name : Mr. Gyan Prakash Singh

Designation : Director
Official Address : Mermaid – 1, Office – 11, Sector – 11, CBD Belapur, Navi Mumbai 400614.
,
Telephone : 09385011963
Residential Address : Plot # 86, Nandanvan CHS, Sector – 17, Nerul, Navi MumbaI 400706
.

Email Address ` : allwell11@yahoo.com

Date :

Place :
 BLISS BIOTECH PVT. LTD .
Mermaid – 1, Office -11, Sector -11, CBD Belapur, Navi Mumbai 400614
Tel . No. 022-22957754 , Fax : 022-27576276
Email : allwell2401@yahoo.com / biotechbliss@yahoo.com

APPENDIX 20 A
FORM OF APPLICATION OF IDENTITY CARD

Photograph
1) Name of the person :.MR. Kalpak B Koli duly attested
(in whose favour Identity by
Card is to be issued) Proprietor/
Partner/
2) Designation of the person : Purchase Manager Director

3) IEC Number : 2101001870

4) Details of Fee :

Bank receipt :

DD No.& date :

Amount Rs :

Name of the Bank :

Branch of issue :

DECLARATION

i) I am the Proprietor/Partner/Director of the firm/company.

ii) I hereby declare that Mr. Kalpak B Koli in whose favour identity card is to be issued is the
Authorised Signatory of the firm.

iii) I further undertake that the document(s) /Licence(s) may be handed over to the Identity Card
holder at the sole risk and responsibility of the firm.

For Bliss Biotech Pvt Ltd

Director.

Name : Mr. Gyan Prakash Singh

Designation : Director
Official Address : Mermaid – 1, Office – 11, Sector – 11, CBD Belapur, Navi Mumbai 400614.
Telephone : 09385011963
Residential Address : Plot # 86, Nandanvan CHS, Sector – 17, Nerul, Navi MumbaI 400706
Email Address ` : allwell11@yahoo.com
Date :

Place :
 BLISS BIOTECH PVT. LTD .
Mermaid – 1, Office -11, Sector -11, CBD Belapur, Navi Mumbai 400614
Tel . No. 022-22957754 , Fax : 022-27576276
Email : allwell2401@yahoo.com / biotechbliss@yahoo.com

Documents to be enclosed with the application form

1. Bank Receipt (in duplicate)/Demand Draft evidencing payment of application fee in terms
of Appendix-29.

2. Two passport size photographs of the person in whose favour identity card is to be
issued.
 BLISS BIOTECH PVT. LTD .
Mermaid – 1, Office -11, Sector -11, CBD Belapur, Navi Mumbai 400614
Tel . No. 022-22957754 , Fax : 022-27576276
Email : allwell2401@yahoo.com / biotechbliss@yahoo.com

To Dt.
The Jt. Director General
Of Foreign trade, IEC No. 2101001870
New C.G.O. Building
New Marine Lines,
Mumbai –400 020.

Dear Sir,

Sub. Application for Identity Card

Please find enclosed here with an Application form Identity Card as per Para 2.16 of the Hand Book.
Documents enclosed as under.

1. Demand Draft No. DT. Amount Rs.

2. Appendix-20A in Duplicate.
3. Appendix –1 IN Duplicate.
4. Self-Certified Copy of IEC No.
5. Self-Certified Copy of RCMC
6.1 Passport size Photos of MR.
7. Self-Addressed Envelop with Rs.20/- Postal Stamp.
8.I card of Mr. for cancellation.(He is no more with our Compan)

Please find the above in order and issue the Identity Card at the earliest.

Thanking you,

FOR

AUTHOROSED SIGNATORY.
Name& Designation

Encl. as above.
BLISS BIOTECH PVT. LTD .
Mermaid – 1, Office -11, Sector -11, CBD Belapur, Navi Mumbai 400614
Tel . No. 022-22957754 , Fax : 022-27576276
Email : allwell2401@yahoo.com / biotechbliss@yahoo.com