(To be typed on Company’s Letterhead)

EXPORT AWARD-2016-17

(ANNEXURE – I)

APPLICATION FORM FOR EXPORT AWARD FOR THE YEAR 2016-17

1. / Name & Address of the Company
2. / Name of the Director’s/ Partner’s/
Proprietor.
3
(a ) / Membership No.(Pl. indicate the Panel in which the Company is registered.)
(b) / Membership Paid for current year i.e 2017-18. / Receipt no. Date .
4. / Category of Registration
i) Manufacture Exporters,
ii)Manufacture cum
Merchant Exporters
iii)Merchant Exporters)
5 / Registration Certificate
(a) / As Micro, Small, Medium Enterprises with State Directorate of Industries.(MSME) / Certificate No.
Date of issue.
(b) / As S.I.A, Ministry of Industry, Government of India, New Delhi. / Certificate No.
Date of issue.
6. / Whether the Company is recognized as Export House/ One Star/ Two Star/ Three Star/ Four Star or Five Star. / Category of Registration:
Certificate No.
Date of issue:
7 / Net Foreign Exchange Earned (2016-17). / 2016-17 : Rs in Million
8(a) / EXPORT PERFORMANCE – ( Category as a Manufacturer Exporters )
Actual Exports (F.O.B.) ( Rs. in Millions )
Products Group / II year prior to year of award 2014-15 / I year prior to year of award 2015-16 / Year of award 2016-17
Quantity / F.O.B Value
(Rs.) / Quantity / F.O.B Value
(Rs.) / Quantity / F.O.B Value
(Rs.)
Dyes & Dye Intermediates
Inorganic, Organic and Agro Chemicals
Cosmetics & Toiletries, Perfumery Compounds and Essential Oils
Specialty Chemicals & Castor Oil
TOTAL
(b) / EXPORT PERFORMANCE – ( Category as a Merchant Exporters ) (Those who are registered as a Manufacturer cum Merchant Exporter they have to give Merchant exporters turnover in this column separately.)
Actual Exports (F.O.B.) ( Rs. in Millions )
Products Group / II year prior to year of award 2014-15 / I year prior to year of award 2015-16 / Year of award 2016-17
Quantity / F.O.B Value
(Rs.) / Quantity / F.O.B Value
(Rs.) / Quantity / F.O.B Value
(Rs.)
Dyes & Dye Intermediates
Inorganic, Organic and Agro Chemicals
Cosmetics & Toiletries, Perfumery Compounds and
Essential Oils
Specialty Chemicals & Castor Oil
TOTAL
9(a) / Item wise Exports as per H S Code No. falling under the preview of this Council.
Products/ ITC (HS) Code / Firm’s Exports in FOB value (Rs.in Million) / Year-Wise percentage (%) growth over preceding year
2014-15 / 2015-16 / 2016-17 / 2015-16 / 2016-17
(b) / Break up of turnover during last 3 financial year of the product (HS Code) Coming under the purview of Council
Year / F.O.B Value of Exports / Domestic Sale / C.I.F. Value of Imports / Total Turnover
2014-15
2015-16
2016-17
(c) / Country-wise breakup of the total exports during the last financial years
Country / F. O. B Value (Rs. in Million)
2014-15 / 2015-16 / 2016-17
10. / Percentage of Exports to total Sales ( for Merchant Exporters).
Percentage of Exports to total production ( Manufacturer. Exporters).
Year / Production / Sales / Exports / %
2014-15
2015-16
2016-17

11. Details of CHEMEXCIL are past awards. (Year-wise)

12. Details of extra-efforts made in export promotion:-

a)Development of New Market :______

b)Development of New Product: ______

c)Successful break-through in New Foreign markets for existing export products.

d)Significant success in developing or acquiring international standards of quality – National, International Certification:

e)Participation in International Fairs / Exhibitions and Business concluded.

f)Foreign business tours and on spot market study.

13. Whether the name of your company is appearing in

DEL STATUS in DGFT or any other Govt. Agencies

defaulters list YES / NO.

DECLARATION

We hereby certify that the information furnished in this form is authentic and correct and we shall abide by the decision of the Trade, Ministry of Commerce & Directorate of Industries.

Signature–

Name-

Designation –

Name of the firm –

(with rubber stamps)