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COA Election Nomination Form 2022-2024

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NOMINATION FORM

THE GEM & JEWELLERY EXPORT PROMOTION COUNCIL ELECTION FOR COMMITTEE OF ADMINISTRATION

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----- Start of picture text ----- For use of Election Authority only - SERIAL NUMBER AS PER ELECTORAL ROLL: PANEL GROUP (Diamond/GJ-OPMJ/Silver/CGS & Pearls/SFT-CFJ-SYS/LGD/SEZ/S\J): CATEGORY (General / Export House/ SEZ / MSME): REGIONAL CHAIRMAN: (Northern Region/Rajasthan Region/Eastern Region/Southern Region/Gujarat Region/Western Region) VICE CHAIRMAN: DATE Stamp and Signature of OF RECEIPT Election Authority ----- End of picture text -----

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----- Start of picture text ----- Note: Only the relevant fields may be filled in the above and leave other fields bank. ----- End of picture text -----

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NOMINATION FORM

(Please fill all the columns in below forms. Do not leave any Column blank)

Name of the Firm / Company

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----- Start of picture text ----- : i primarily classified: : ----- End of picture text -----

Address
Name of the Panel in which Firm/Company primarily classified: (Refer Membership Certificate for 2022-23)

of GJEPC

with this office

(Mumbai / Surat / Jaipur/ Delhi / Chennai / Kolkata).

5. Whether the member firm is status holder (EH/TH/STH/SSTH etc)

: YES / NO

(If yes, please attach the self-attested copy of status holder certificate with this form)

The Member filling his nomination for MSME category should attach self-certified copy of MSME certificate issued by DIC / appropriate Government Authority.
Particulars of the candidate being nominated:

i) Name & Designation :

ii) Father's Name:

iii) Residential Address including Telephone number:

iv) Director Identification Number (DIN) issued by Ministry of Corporate Affairs (MCA) (Wherever applicable)

As per para 4.2 (c) of the Election Rules, in order to stand for elections, the entity represented by him must have to her/ his/ its credit export of not less than the amount mentioned in the table for that particular item.

Please enclose original certificate duly signed from Chartered Accountant certifying export performance in Indian Rupees rounded off to nearest Lakh. (Format of CA certificate given in Annexure A — 1).

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The Director, Partner, Proprietor as the case may be who is an authorized person (candidate), of the company / Firm should give an undertaking along with the Nomination Form itself, that if any other partner / director is being authorized to submit the withdrawal letter on his/her behalf, and in case any employee is authorized then he / sheis in full time employment of the company/ firm concerned. (Format of undertaking given in Annexure: A — 2).

withdrawal letter on his/her behalf, and in case any employee is authorized then he / sheis in full time employment of the company/ firm concerned. (Format of undertaking given in Annexure: A — 2).

The Director / Partner / Proprietor, as the case may be of the Company/Firm should furnish an undertaking along with Nomination form, that the Company/Firm is not debarred/black listed under DEL by the Directorate General of Foreign Trade, Govt. of India as per existing Foreign Trade Policy. (Format of undertaking given in Annexure: A — 3).
With regard to para 4.2 (m) & (n) of the Election Rules, the candidate needs to furnish the undertaking regarding his/her tenure as a Panel member of the Committee of Administration/Regional Chairman as the case maybe as per format given in Annexure A-4.
With regard to Rule 9 (ii) of the Election Rules, an undertaking needs to be submitted that in course of pendency of tenure of any serving member of the Committee of Administration, if the turnover of his entity whom he represents, falls below the turnover as specified in Rule 4.2 (c), vide which he/she has gained the eligibility of getting elected in CoA, OR if the member loses his Ordinary membership status and gets converted to Associate membership, such person shall suo moto duly inform the Council of such developments vide a written communication at the earliest. Further, that member will duly retire at the end of the concerned financial year and the election for such post will be held at the immediately next election with other seats falling vacant.

arliest. Further, that member will duly retire at the end of the concerned financial year and the election for such post will be held at the immediately next election with other seats falling vacant. (Format of undertaking given in Annexure: A — 5).

| declare that all the information provided in this form and in the annexures attached to this form are true to the best of my knowledge and belief.

Signature of the Candidate

Name:

Designation:

(Rubber Stamp of Company)

Attestation of the signature of the person signing Nomination Form by banker of the Member / Company concerned.

Attested by

Name of the bank official:

Designation:

(Official Stamp of Bank)

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- 1 FORMAT OF CHARTERED ACCOUNTANT'S CERTIFICATE (Refer Point No. 8 above)

This is to certify that we have verified Books of Accounts and other records of M/s.

having their head office /

registered office at

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----- Start of picture text ----- and certify that their FOB value of physical export of Gems & Jewellery item during the year(s) indicated hereunder is as follows: Year FOB value of physical export of gems & jewellery in item ( ). (Rs. in Lakhs) 1. 2021-2022 INR in Lakhs 2. 2020-2021 INR in Lakhs 3. 2019-2020 INR in Lakhs Average Export during INR in LARA last 3 years —=———— ----- End of picture text -----

Signature: Name of the Chartered Accountant Registration No & Seal / Rubber Stamp of CA Firm: Date & Place

Note:

Please specify name of the item of export at the appropriate place above for the Panel Representation. For SFT Panel the figure of sales to foreign tourists will have to be mentioned.
For Regional Chairman / Vice-Chairman it can be any product or total gems & jewellery items. 3. Export figures to be rounded off to the nearest Rs in lakh. Please refer Para 3.4 (iii) of the above notice or Rule 4.2 (c) of the election rules for the eligibility criteria with regard to export turnover. Original Certificate duly signed by Chartered Accountant is mandatory. Photostat copies of CA certificate will not be acceptable.
A member not having qualifying exports will not be eligible to file nomination to be a member of the Committee of Administration of the Council.

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(Format of Undertaking)

Please refer point no 9 above and then fill only if applicable.

This is to certify that the person being authorized to submit the withdrawal letter on behalf of the undersigned is

One of the Partner/ Director of the Company / Firm as per specimen signature given below.

OR

An Employee who is in full time employment of the Company/Firm as per specimen signature given below.

(Strike off whichever is not applicable).

Signature: (Signature of the Candidate )

Name:

Designation:

(Rubber Stamp of Company / Firm )

(Specimen Signature of the Partner / Director/Employee)

Signature:

Name:

Designation:

Date:

Note: Please refer point no 9 above and then fill only if applicable.

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(Format of Undertaking for DEL status on the letterhead)

This is to certify that our Company/Firm bearing [EC number

has not been debarred/black listed under DEL by the Directorate General of Foreign Trade, Govt. of India as per existing Foreign Trade Policy of Govt. of India (Refer Election Rules).

Signature: (Authorised Representative as per GJEPC records)

Name:

Designation:

Date:

(Rubber Stamp of Company)

Note:

e Please refer http://dgftcom.nic.in/licasp/iecDenQuery.asp in relation to point no 10 of the nomination form.
e Also mention the IEC number at the appropriate place above.

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(Format of Undertaking regarding tenure ship on the letterhead)

| hereby declare that the undersigned has not served as Regional Chairman for 3(three) continuous terms of 2 (two) years each / Panel Member of the Committee of Administration for continuous period of 6 (six) years.

| hereby declare that the undersigned has not served as a Chairman for a term of two years in the term immediately preceding the term for which the elections are being conducted. (Remove/strike out whichever is not applicable based on nomination)

Signature of the Candidate: Name:

Designation: Date:

(Rubber Stamp of the Company )

Note: Please refer Rule 4.2 (m) & (n) of the Election Rules and also refer to Rule 4.2 (p)

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(Format of Undertaking on letterhead regarding Ineligibility from Membership during tenure)

In accordance to Rule9 (ii) of the Election Rules

IMWe hereby declare to suo motu inform the Council at the earliest vide a written communication in case of a scenario whereby the export of my entity, which | represent, falls below the export as specified in Rule 4.2 (c), vide which | have gained the eligibility of getting elected in CoA, OR if the entity which | represent loses its ordinary membership status in any financial year during the pendency of my tenure.

Further, | acknowledge that in case of an occurrence of the above-mentioned scenario, | would stand to duly retire at the end of the concerned financial year in which such disqualification is attained.

Signature of the Candidate:

Name:

Designation:

Date:

(Rubber Stamp of the Company )

Note: Please refer Para 9 (ii) of the Election Rules and Point no. 12 of the Nomination Form in relation to the above declaration.

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----- Start of picture text ----- ANNEXURE - B ----- End of picture text -----

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----- Start of picture text ----- FORM FOR PROPOSER / SECONDER / NOMINEE ----- End of picture text -----

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----- Start of picture text ----- Date : V C Chaturvedi Jt. Director General of Foreign Trade & Election Authority for GJEPC Nishtha Bhavan, 48, Vithaldas Thackersey Marg, Churchgate, Mumbai 400 020 Dear Sir, I, propose Mr./Mrs./Ms. a M/s ----- End of picture text -----

for election as a member of the Committee of Administration of the Gem & Jewellery Export Promotion Council for PANEL / GROUP OF PANEL & Category (EH/SEZ/MSME etc.) for the term 2022-2024. (Pls specify Panel / Group of Panels / Category (refer para 2(b) of Election Rules) and Nomination Notice.)

OR

for REGIONAL CHAIRMAN of Region for the term 2022-2024. (pls specify Region. Refer election rules or point of the nomination notice)

OR

for VICE CHAIRMAN (pls specify and refer point no 2.3 of the notice) for the term 2022-2024. (Strike out whichever is not applicable).

Yours faithfully,

| propose the above nomination:

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Signature of the Proposer (*)

Name of the person in BLOCK letters (Proposer*):

Name of the firm and address : Serial No. in Electoral Roll: Membership no: with this office of GJEPC .

(refer Membership Certificate)

Seal / Rubber Stamp of the Proposer’s firm

| second the above nomination

Signature of the Seconder (*)

Name of the person in Block Letter (seconder*):

Name of the firm and address : Serial No. in Electoral Roll: Membership no: with this office of GJEPC .

(refer Membership Certificate)

Seal / Rubber Stamp of the Seconder’s firm

Name of the Nominee/candidate in BLOCK Letters

Name of the Firm and address:

Serial No. from electoral Roll:

Membership no:

(refer Membership Certificate)

with this office of GJEPC , | agree to the above nomination Page 22 of 24

Signature of the Nominee / candidate

Seal/Rubber Stamp of the Nominee’s firm

General Notes:

1. Please fill in all the columns. Do not leave any column blank. 2) Strike out or write N.A. at places whichever are not applicable in the form. 3) For Panel / Group of Panels / Category (refer para 2(b) of Election Rules) and Nomination Notice. 4) Amember not having qualifying exports will not be eligible to file nomination to be a member of the Committee of Administration of the Council. (Please refer election Rules)
1. Typed Copies of this proforma can be used by the member for nomination if necessary. 6) *Proposer & Seconder should also be an ordinary member eligible to vote from the respective Panel / Group of Panels if nomination is for Panel representation and from the respective Region if nomination is for Regional Chairman.
1. For Vice Chairman the Proposer & Seconder can be an Ordinary member eligible to vote from any Panel or Region.
1. Proposer, Seconder and Nominee should affix their firm's Rubber Stamps at the specified place and also mention the membership no and location of office of GJEPC where the membership is registered.
1. Proposer, Seconder and Nominee should write the SR NO from the Electoral Roll at the specified places.
1. A member should provide details of the Director Identification Number (DIN) as allotted to him by the Ministry of Corporate Affairs and the same should be quoted.

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ANNEXURE - C

ADDRESS AND OTHER DETAILS OF ELECTION AUTHORITY Shri V C Chaturvedi Joint Director General of Foreign Trade, Nishta Bhavan,

48, Vithaldas Thackersey Marg, Churchgate, Mumbai 400 020 Tel: 022-22038094/22017716/22033097/22031074. Direct Tel: 22001250 E-Mail: mumbai-dgft@nic.in

Shri Abhishek Sharma

Jt. Director General of Foreign Trade, Government of India, Udyog Bhawan, IlIrd Floor, Tilak Marg, Jaipur - 302 005 Tel. No.: +91 - 141 - 222 7539 / 7902 Fax No.: +91 - 141 - 222 7604 E-mail ID: jaipur-dgft@nic.in

Shri Dona Ghosh

Joint Director General of Foreign Trade, 4, Esplanade East, Kolkata - 700 069 Tel. No.: +91 - 33 - 2248 6831/32/33/34 Fax No.: +91 - 33 - 2248 5892 E-mail ID: kolkata-dgft@nic.in

Shri D T Parate

Joint Director General of Foreign Trade

6th Floor, Resham Bhavan, Lal Darwaja, Surat - 395 003 Tel. No.: +91 - 261 - 242 3381/2453381 Fax No.: +91 - 261 - 245 2216 E-mail ID: surat-dgft@nic.in

Shri B N Vishwas

Joint Director General of Foreign Trade,

4th Floor Shastri Bhavan Annex,

26 Haddows Road, Nungambakkam, Chennai - 600 004 Tel. No.: +91 - 44 — 2828 3404 /408 Fax No.: +91 - 44 - 2828 3403 E-mail 1D: Chennai-daft@nic.in

Joint Director General of Foreign Trade

Ministry of Commerce & Industry

"A" Wing Indraprastha Bhawan I.P. Estate, New Delhi - 110002 Tel.No.: 011-23378737/ Fax No. +91-11- 23379114 E-mail ID: cladelhi-dgft@nic.in

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