Export Declaration Form
1. General Information
| Type of export | Service | Form No. | |
|---|---|---|---|
| Shipping Bill No. and Date | Not applicable (services) | Mode of Transport/Delivery | Internet |
| Category of Exporter | others (Specify): Service exporter | AD code | |
| IE Code | AD Name and Address | , | |
| GSTIN | PAN | ||
| Exporters Name and Address | , | Mode of Realisation | Others |
| Consignee Name and Address | Port of Loading / Source Port in case of SEZ | Not applicable | |
| Third Party name and Address (in case of third-party payments for Exports) | Country of Final Destination | ||
| Relationship between Exporter and Third Party | Port of Discharge | Not applicable | |
| Name of the AD and AD code, in case of LC/BG | Not applicable | Date of Let Export Order (LEO) | Not applicable |
| Description of Goods/Services | |||
| Total FOB/Services value in words (INR) | |||
2B. Details of Export Value^ of Services
Details of services provided to multiple recipients
| S. No. | Service recipient Name and Address | Country | Details of Invoice (No., Date, Currency, Amount) | Net Realisable value | Contract No., if any, and Date | Description of services | SAC Code | Remarks |
|---|
4. Declaration by the Exporters (All types of exports)
I /We hereby declare that I/we @am/are the seller/consignor of the goods/ provider of services in respect of which this declaration is made and that the particulars given above are true and that the value to be received from the buyer/third party represents the export value^ contracted and declared above. I/We undertake that I/we have delivered/ will deliver to the authorised dealer named above the foreign exchange / Indian Rupees representing the full value of the goods/services exported as above on or before ………… (i.e. within the period of realisation stipulated by RBI from time to time) in the manner specified in the Regulations made under the Foreign Exchange Management Act, 1999.
I/We also undertake to submit the documents pertaining to exports declared in this form, to the Authorised Dealer named above, as may be required under the Act.
Date: ____________
(Signature of Exporter)
5. Space for use of Specified Authority (Custom/SEZ/AD/STPI)
Certified, on the basis of above declaration at 4, that the goods/services described above and the export value^ declared by the exporter in this form is as per the corresponding invoice/gist of invoices submitted and declared by the exporter.
Date:
(Signature of Designated/Authorised officials of Custom /SEZ/ Authorised Dealer/STPI)
1. @ Strike out whichever is not applicable.
2. ^ If the full export value is not ascertainable at the time of export, the value which the exporter, having regard to the prevailing market conditions expects to receive on the sale of the goods in overseas market.
3. Export value may be indicated as nil in case the goods are sent without any consideration.
Parts 2A (goods) and 3 (FPO/courier exports) are not applicable to this declaration of services. Part 4 "on or before" date: the earliest realisation date of the invoices above (9 months from the invoice date; 12 months if invoiced in INR).