| IMPORTERS DATA |
| NAME OF IMPORTER | : |
| IMPORTER'S ADDRESS | : |
| CITY | : |
| STATE | : |
| PINCODE | : |
| TELEPHONES | |
| Office | : |
| Residence | : |
| Fax | : |
| Mobile | : |
| Pager | : |
| Telex | : |
| IMPORTER-EXPORTER CODE (IEC) NO | : |
| INCOME TAX PAN NO. | : |
| DETAILS OF BANK ACCOUNT, IF ANY | |
| Name of the Bank | : |
| Address | : |
| Branch code | : |
| Nature of account | : |
| Account number | : |
| NAME AND SIGNATURE | |
| ( Authorised Signatory) |
| Notes |
|
1. Please enclose attested copies of IEC and PAN certificates |
|
2. All columns should be written legibly and in CAPITAL letters |
| 3. Please enclose a certificate from the bank cetifying the details at Sl. No. 9 |