--:: SURAT SPECIAL ECONOMIC ZONE ::--

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)

Signature of the Proprietor/Partner(s)/ Director(s) / Karta

Place : __________________

Name : __________________

Date : __________________

Designation : __________________

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