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EXCHANGE CONTROL DECLARATION (GR) FORM NO.





Ozg FEMA Consultant

Phone # 09811415831-37-61-72-84-92-94

Website: fema.in 

Original

Exporter
Invoice No.& Date
SB No.& Date






AR4/AR4A No.& Date







Q/Cert No.& Date
Importer-Exporter Code No.





Consignee








Export Trade Control
If export under:




Deferred Credit [ ]



Joint Ventures [ ]



Rupee Credit [ ]



Others [ ]



RBI's Approval/Cir.No. & Date

Custom House Agent L/C.No.









Pre-Carriage by
Place of Receipt

Type of shipment :



by Pre-Carrier

Outright Sale [ ]




Consignment Export [ ]

Vessel/Flight No.
Rotatio No.

Others [ ]




(Specify)







Port of Loading
Nature of Contract:CIF[ ]/C&F [ ]/FOB [ ]




Other (Specify) [ ]





Port of Discharge
Country of Destination

Exchange Rate U/S 14 of CA Currency of invoice





S.No
Marks & No. No. & Kind of Pkgs.
Statistical Code & Description of Goods
Quantity
Value FOB

Container Nos.










Net Weight











Gross Weight











Total FOB Value in words



Analysis of Export Value
Currency Amount
Full export value OR where not ascertainable, the



value which exporter expects to receive on the sale of goods.

FOB Value



Freight





Insurance



Currency



Commission

Rate





Discount



Amount



Other Deductions























2
EXCHANGE CONTROL DECLARATION (GR) FORM NO.

Is Export under L/C arrangements? Yes [ ] No [ ]
FOR CUSTOMS

If yes, name of advising bank in India
Customs Assessable value Rs.





(Rupees .


........................................................................................




Bank through which payment is to be received



Export Value Verified









Customs Appraiser




Whether Payment is to be received through the

Date of Shipment
Customs Appraiser

ACU YES/NO





Declaration under Foreign Exchange Management Act, 1999: I/We hereby declare that I/We am/are the *SELLER/CONSIGNOR of the goods in respect of which this declaration is made and that the particulars given above are true and that a)*the value as contracted with the buyer is the same as the full export value declared overleaf/ b) *the full export value of the goods is not ascertainable at the time of export and that the value declared is that which I/We, having regard to the prevailing market-conditions, expect to receive on the sale of goods in the overseas market.



I/We undertake that I/We will deliver to the bank named herein the foreign exchange representing the full export value of the goods on or before @ .................................. in the manner soecified in the Regulations  under the Act. I/We further declare that I/We am/are resident in India and I/We have a place of business in India.



I/We* am/are OR am/are not in Caution List of the Reserve Bank of India.

......................................

Date................                                                            (Signature of Exporter)



@ State appropriate date of delivery which must be within six months from the date of shipment, but for exports to warehouses established outside India with the permission of the Reserve Bank, the date of delivery must be within fifteen months.





* Strike out whichever is not applicable



SPACE FOR USE BY RESERVE BANK OF INDIA

























EXCHANGE CONTROL DECLARATION (GR) FORM NO.

Duplicate

Exporter
Invoice No.& Date
SB No.& Date






AR4/AR4A No.& Date







Q/Cert No.& Date
Importer-Exporter Code No.





Consignee








Export Trade Control
If export under:




Deferred Credit [ ]



Joint Ventures [ ]



Rupee Credit [ ]



Others [ ]



RBI's Approval/Cir.No. & Date

Custom House Agent L/C.No.









Pre-Carriage by
Place of Receipt

Type of shipment :



By Pre-Carrier

Outright Sale [ ]




Consignment Export [ ]

Vessel/Flight No.
Rotation No.

Others [ ]




(Specify)







Port of Loading
Nature of Contract:CIF[ ]/C&F [ ]/FOB [ ]




Other (Specify) [ ]





Port of Discharge
Country of Destination

Exchange Rate U/S 14 of CA Currency of invoice





S.No
Marks & No. No. & Kind of Pkgs.
Statistical Code & Description of Goods
Quantity
Value FOB

Container Nos.




















Net Weight











Gross Weight











Total FOB Value in words



Analysis of Export Value
Currency Amount
Full export value OR where not ascertainable, the



value which exporter expects to receive on the

FOB Value

sale of goods.

Freight





Insurance



Currency



Commission

Rate





Discount



Amount



Other Deductions























2
EXCHANGE CONTROL DECLARATION (GR) FORM NO.



Is Export under L/C arrangements? Yes [ ] No [ ]
FOR CUSTOMS

If yes, name of advising bank in India
Customs Assessable value Rs.





(Rupees .


........................................................................................

Bank through which payment is to be received



Export Value Verified









Customs Appraiser


Cargo shipped in full/part


Quantity


Value

Whether Payment is to be received through the

Date of Shipment
Customs Appraiser

ACU YES/NO





Declaration under Foreign Exchange Management Act, 1999: I/We hereby declare that I/We am/are the *SELLER/CONSIGNOR of the goods in respect of which this declaration is made and that the particulars given above are true and that a)*the value as contracted with the buyer is the same as the full export value declared overleaf/ b) *the full export value of the goods is not ascertainable at the time of export and that the value declared is that which I/We, having regard to the prevailing market-conditions, expect to receive on the sale of goods in the overseas market.



I/We undertake that I/We will deliver to the bank named herein the foreign exchange representing the full export value of the goods on or before @ ................................... in the manner specified in the Regulation made under the Act.



I/We further declare that I/We am/are resident in India and I/We have a place of business in India.



I/We* am/are OR am/are not in Caution List of the Reserve Bank of India.

......................................

Date................                                                        (Signature of Exporter)



@ State appropriate date of delivery which must be within six months from the date of shipment, but for exports to warehouses established outside India with the permission of the Reserve Bank,  the date of delivery must be within fifteen months.



* Strike out whichever is not applicable



FOR AUTHORISED DEALER'S USE

Uniform Code Number.........................

*Indicate ( ) in the box applicable Date of* (I) negotiation (ii) receipt for collection. Bill No..........................

Type of Bill* (i)DA[ ]/(ii)DP [ ]/(iii)Others [ ]....................(Specify)

Type of shipment:*(i) Firm Sale Contract [ ]/(ii)Consignment Basis [ ]/

(iii)Others [ ] .......................(Specify)

The GR Form was included in the Statement sent to the Reserve Bank with

the R Return for the fortnight ending...........................sent on.......................

We certify and confirm that we have received the total amount of..............……………

                                                                                                   (Currency) (amount)

as under being the proceeds of exports declared on this form.







3

Date of receipt
Currency
Credit to Nostro Account in-------------------Country
Debit to NR Rupee Account of a Bank in -------------Country
Period of R Return with which the realisation has been reported to RBI


In our name
In the name of *--------------------------
Held with us
Held with * ---------------------

(1)
(2)
(3)
(4)
(5)
(6)
(7)





















* (Write the name of the concerned Indian Authorised Dealer Branch. ) Any other manner of receipt (Specify)....................................................................................................................


---------------------------------------
(Stamp & Signature of authorised dealer)
Date:........................................
Address:.......................................................
................................................
................................................










Ozg FEMA Consultant

Phone # 09811415831-37-61-72-84-92-94

Website: fema.in