EXCHANGE CONTROL DECLARATION (GR) FORM NO. 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 . ....................................................................................... 2 . 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 3 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. 4 (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) 5 * (Write the name of the concerned Indian Authorised Dealer Branch. ) Any other manner of receipt (Specify).................................................................................................................... --------------------------------------- (Stamp & Signature of authorised dealer) Date:........................................ Address:....................................................... ................................................ ................................................
