IN FORCE SEZ / EOU / FTWZ undated

ईओयू के लिए एएनएफ 6

Document text

ANF-6A

APPLICATION FORM FOR SETTING UP OF NEW EOU/EHTP/STP/BTP UNIT OR CONVERSION OF EXISTING DTA/ EHTP/ STP/BTP UNIT

Note:

Please see Paras 6.01 (a), (b) and (c) of the Chapter 6 of the HBP.
Please read the general instructions given in EOU scheme before filling this application and also some important guidelines given at the end of this application.
The application may be sent electronically or otherwise. However the same will be treated as incomplete without the applicants own permanent e-mail and will not be considered.

The application should be submitted to the Development Commissioner of the concerned Special Economic Zone (for setting up EOUs in 3 copies along with a crossed Demand Draft of Rs. 5,000/- drawn in favour of the Pay & Accounts Officer, Ministry of Commerce & Industry, Department of Commerce, payable at the Central Bank of India, Udyog Bhavan, New Delhi. (NO FEE SHALL BE CHARGED FOR RENEWAL/ EXTENSION OF LOP/ BROAD BANDING ETC.)

For Official Use only

Application No.

Date :

Date
Month
Year

Details of Bank Draft

Amount Rs.

Draft No.

Draft date

Drawn on

(Name of the Bank)

Payable at

(Name of the Bank)

Payable at

T his im age c ann ot c urrent ly be dis played.

Indicate (√ ) Whether the Application Is For: AUTOMATIC APPROVAL Or

BOARD OF APPROVAL

Application for:
(i) Setting up of new Unit (ii) Conversion of existing DTA unit into EOU (iii) Conversion of Existing STP/EHTP to EOU

(In case of conversion, please attach fact sheet as per Annexure)

I. NAME AND ADDRESS OF THE UNDERTAKING IN FULL (Block Letters)

Name of the Applicant Firm

Full Address

(Regd. Office in case of limited companies & Head Office for others) Pin Code

Tel. No.

Fax No.

Permanent E-Mail Address

Web-Site, if any

Passport No., if any

Name of Bank with Address & A/c No.

Digital Signature

Income Tax PAN

IEC No., if any

The name and address of each

of the Director/Partner

II. NATURE OF THE APPLICANT FIRM:

T his im age c ann ot c urrent ly be dis played.

II. NATURE OF THE APPLICANT FIRM:

T his im age c ann ot c urrent ly be dis played.

[Please tick (√ ) the appropriate entry]

Government Undertaking/Public Limited Company/Private Limited Company/ Proprietor ship/Partnership/Others (please specify)

Note:- Copy of certificate of incorporation along with Article of Association and Memorandum in case of companies and partnership deed in case of partnership firms may please be attached.

III. INDICATE WHETHER THIS PROPOSAL IS FOR [Please tick (√) the appropriate entry]. Establishment of a New Undertaking

Manufacturing [ ]

Services [ ] Effecting Substantial Expansion Manufacturing of New product

IV. (1) Location of the proposed undertaking

Full Address

Pin code

(2) ONLY FOR PROJECTS UNDER EOU SCHEME (In case the unit is proposed to be located on leased premises, then lease should be obtained from Government or any undertaking / authority of Government. However in case lease is obtained from private parties, it shall have a validity period of five years from the date of LUT and the Development Commissioner shall satisfy himself of genuine nature of the lease.)

(a) Please indicate if the proposed location is in a Centrally Notified Backward Area [Please tick (√) the appropriate entry].

No.

oner shall satisfy himself of genuine nature of the lease.)

(a) Please indicate if the proposed location is in a Centrally Notified Backward Area [Please tick (√) the appropriate entry].

No.
Yes
if yes, indicate category

(b) Indicate whether it is within 25 Kms from the periphery of the standard urban area limit of city having population above one million according to 1991 census.

Yes
No.

(c) Is it located in an Industrial Area/Estate designated/set up prior to issuance of Notification No. 477(E) dated 25th July,1991.

Yes
No.

(d) If not, does it come under the category of non-polluting industries as notified by the Govt.

Yes
No.

V ITEM (S) OF MANUFACTURE/SERVICE: (Including By-product/Co-products) (if necessary, additional sheets may be attached)

Items(s) Description Capacity (Unit =) Item Code (ITC HS code No) (Not required for service unit)

V-A Intermediate Products, if any, which are to be taken out for job work abroad as part of production process.

Item(s) Description Quantity

Item Code(ITC HS Code No.) (Not required for service unit)

VI. PRODUCTION (In case of more than one item, supplementary sheets may be used)

(1 $ = Rs.

em Code(ITC HS Code No.) (Not required for service unit)

VI. PRODUCTION (In case of more than one item, supplementary sheets may be used)

(1 $ = Rs. )

Rupees (lakhs) US $ (Thousand) 1st year 2nd year 3rd year 4th year 5th year Total:

IX. INVESTMENT: (RS. IN LAKHS) Quantity (Unit
) (Not required for service unit) (Value (In Rupees) 1st year 2nd year 3rd year 4th year 5th year

VII. Indigenous Requirement: a) b) Capital Goods Raw material, components, consumables, packing material, fuel etc. during the period of 5 years (Value in Rupe TOTAL:

VIII. FOB VALUE OF EXPORTS

(a) Land

(b) Building

(i) Indigenous (US $ Thousand) (ii) Import CIF value

(iii) Total (i) + (ii)

(d) Details of source(s) of finance, (both Indian as well as foreign) for the above investments

X. WHETHER FOREIGN TECHNOLOGY AGREEMENT IS ENVISAGED (Please tick ( √ ) the appropriate entry )

Yes

(I) Name and Address of foreign collaborator

(ii) Terms of collaboration (Rupees lakhs) (Gross of Taxes) (a) Lumpsum payment

(b) Design & Drawing fee

(d) Royalty (on exports)

% (e) Royalty (on DTA sales if envisaged)

(f) Duration of agreement

(No .of years)

XI.

esign & Drawing fee

(d) Royalty (on exports)

% (e) Royalty (on DTA sales if envisaged)

(f) Duration of agreement

(No .of years)

XI. EQUITY INCLUDING FOREIGN INVESTMENT

(i) ($ Thousand) (Rs.lakhs)

(a) Authorized

(b) Subscribed

Note: If it is an existing company, please give the break up of the existing and proposed capital structure

(ii) Pattern of share holding in the paid-up capital (Amount in Rupees)

(Rs. in lakhs) (US $ Thousand)

(a) Foreign holding

(b) Non Resident Indian company / Individual holding

(i) Repatriable

(ii) Non-repatriable

(d) Total (a+b (i+ii)+c) equity

(e) (iii) External commercial Borrowing

Foreign Exchange Balance sheet:

1st 2nd 3rd 4th 5th (5 yrs) Total in Rs. Lakh (5 Yrs) Total in US $ Th. XII. FOB value of exports in first five years XIII. Foreign Exchange outgo on (I) Import of machinery (ii) Import of raw materials and components (iii) Import of spares and consumables (iv) Repatriation of dividends and profits to foreign collaborators (v) Royalty (vi) Lump sum know-how

i) Import of raw materials and components (iii) Import of spares and consumables (iv) Repatriation of dividends and profits to foreign collaborators (v) Royalty (vi) Lump sum know-how

fee (vii) Design and drawing fee (viiii) Payment of foreign technicians (ix) Payment on training of Indian technicians abroad (x) Commission on Export etc. (xi) Foreign Travel (xii) Amount of interest to be paid on external commercial borrowing/ deferred payment credit (specify details) (xiii) Any other payments(specify details) Total (i)to(xiii) Net Foreign Exchange earnings in five years

XIV. REJECTS (Only for EOU manufacturing units.)

Generation of Rejects/Sub-standard

finished goods

(percentage of 5 yrs production)

Goods (In case rejects are more than 5% estimated percentage with justification may be given

(Qty.(Unit = )

Value (Rs. Lacs) XV. EMPLOYMENT (All figures in number) Existing Proposed

imated percentage with justification may be given

(Qty.(Unit = )

Value (Rs. Lacs) XV. EMPLOYMENT (All figures in number) Existing Proposed

a) Supervisory Men

Women

b) Non-supervisory Men

Women

XVI. NET FOREIGN EXCHANGE EARNING

Average NFE on FOB value of exports in

Block period, as per para 6.04 of FTP.

XVII. MARKETING

a) Whether marketing tie-up/Buy-back

envisaged/finalized (Attach documents,

if any) Yes

G. C. A. R. P. A. b) Destination of exports (in percentage)

XVIII OTHER INFORMATION

i) Any special features of the project proposal

which you want to highlight

(please attach the project report, for new units)

ii) (a) Whether the applicant has been issued any

Industrial license or LOI/LOP under EOU/

STP/EHTP scheme if so, please

give full particulars especially reference number, date of issue, items of manufacture and progress of implementation of each project.

(b) Whether the applicant has submitted any other application for LOI/LOP which is pending with the Board of Approvals. If so, please give particulars like reference number, name under which application made, items of manufacture etc.

any other application for LOI/LOP which is pending with the Board of Approvals. If so, please give particulars like reference number, name under which application made, items of manufacture etc.

iii) Whether the applicant or any of the partners/Directors who are also partners /Directors of another company or its associate concerns are being proceeded

against or have been debarred from getting any License/Letter of Intent/ Letter of Permission under the Export and Import (Control) Act, 1947/Foreign Trade (Development and Regulation) Act, 1992, as amended / FEMA / CGST/SGST/UTGST/IGST Acts of 2017 / Custom/Central Excise Act.

Place :

Signature of the Applicant

Date :

Name in Block Letters

Designation

Official Seal/Stamp

Tel. No.

e-mail

Web-Site, if any

Full Residential Address

DECLARATION / UNDERTAKING

1 . I/We hereby declare and certify that : A. the entity for whom the application has been made have not been penalized under any of the following Acts (as amended from time to time): (i) The Customs Act, 1962, (ii) The Central Excise Act 1944, (iii) Foreign Trade (Development & Regulation) Act 1992, (iv) The Foreign Exchange Management Act,1999, and (v) Under the relevant provisions of GST /CGST/SGST / UTGST/IGST Acts of 2017 B.

1944, (iii) Foreign Trade (Development & Regulation) Act 1992, (iv) The Foreign Exchange Management Act,1999, and (v) Under the relevant provisions of GST /CGST/SGST / UTGST/IGST Acts of 2017 B. none of the Proprietor / Partner(s) / Director(s) / Karta / Trustee of the firm / company, as the case may be, is/are a Proprietor / Partner(s) / Director(s) / Karta / Trustee in any other firm / Company which is on the Denied Entity List (DEL) of DGFT; C. neither the Registered Office / Head Office of the firm / company nor any of its Branch Office(s)/ Unit(s)/ Division(s) has been declared a defaulter and has otherwise been made ineligible for undertaking import / export under any of the provisions of the Policy; D. we have not obtained nor applied for issuance of an Importer Exporter Code Number in the name of our Registered / Head Office or any of our Branch(s) / Units(s) / Division(s) to any other Licensing Authority 2. I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, as amended from time to time, the Rules and Orders framed there under, the Foreign Trade Policy, the Handbook of Procedures and the ITC (HS) Classification of Export & Import Items. 3. I/We hereby declare that the above statements are true and correct to the best of my/our knowledge and belief. I/We will abide by any other condition, which may be stipulated by the concerned Development Commissioner.

that the above statements are true and correct to the best of my/our knowledge and belief. I/We will abide by any other condition, which may be stipulated by the concerned Development Commissioner. I/We fully understand that any Permission Letter granted to me/us on the basis of the statement furnished is liable to cancellation or any other action that may be taken having regard to the circumstances of the case if it is found that any of the statements or facts therein are incorrect or false. An affidavit duly sworn in support of the above information is enclosed. 4. I/We fully understand that any information furnished in the application if found incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted. 5 I/We hereby declare that the particulars and the statements made in this application are true and correct to the

best of my/our knowledge and belief and nothing has been concealed or held there from. 6 I hereby certify that I am authorized to verify and sign this declaration as per Paragraph 9.06 of the Policy

Place:

Signature of the Applicant

Date:

Name in Block Letters

Designation

Official Full Official address

Seal/Stamp

Tel. No.

e-mail Address

Web-Site

Full Residential address

Tel. No

SOME IMPORTANT GUIDELINES

Additional Information may be furnished by existing domestic units seeking conversion into the EOU Scheme as per annexure.

Tel. No

SOME IMPORTANT GUIDELINES

Additional Information may be furnished by existing domestic units seeking conversion into the EOU Scheme as per annexure.

Normally raw material tie-ups are not insisted upon but this may be necessary in cases, such as granite/marble/sandstone products where availability of raw materials is contingent upon Government leases etc.

Normally lumpsum amount up to US $ 2 Million and 8% royalty (net of taxes) as amended from time
to time over a period of five years from the commencement of production is allowed as per the current EOU Scheme on account of foreign technology agreement as per the norms of Department of Industrial Policy and Promotion. In addition selling agency commission is permitted as per RBI norms.

ANNEXURE

PROFORMA TO BE FILLED IN BY THE EXISTING DTA UNITS SEEKING CONVERSION INTO THE EOU SCHEME

a) Whether conversion of DTA Unit into the EOU has been sought for the full existing capacity of the unit or the proposal is for partial conversion.(Please give details of the existing capacity etc.) b) Whether any expansion of the DTA unit proposed to be converted into EOU has been envisaged, if so the extent thereof.(Please give details of the existing capacity and the enhanced capacity etc). c) What is the level of existing exports of the unit proposed to be converted into EOU.

ged, if so the extent thereof.(Please give details of the existing capacity and the enhanced capacity etc). c) What is the level of existing exports of the unit proposed to be converted into EOU. (Please give details of export performance item- wise for a minimum of three previous years) d) Whether the DTA unit is already under obligation to export, under: i) Advance Licensing Scheme; ii) Import of machinery under EPCG scheme; iii) Any other Scheme. (Give all relevant details including total E.O. imposed, the E.O. discharged till date etc.) e) Whether your unit is registered with the Customs/ Excise authorities and GST. (Please give details viz. Reg. No., date etc.) f) Deleted. g) Whether you are a merchant exporter or a manufacturer exporter.(Please give details) h) What is the age(year of manufacture)and residual life of items/ machinery already installed in your unit, whether they are imported or indigenous.(Please attach separate sheets giving item-wise details with value of the new CG as well as existing value of machinery presently installed).

Date

Signature

Name

Place

Address of the Applicant

te sheets giving item-wise details with value of the new CG as well as existing value of machinery presently installed).

Date

Signature

Name

Place

Address of the Applicant

ANF-6B APPLICATION FOR EXTENSION OF LOP FOR EXPORT ORIENTED UNITS (Please see Paras 6.05 (a) of FTP & Para 6.34 of HBP) 1. Name and Address of the unit. 2. Date of LOP granted and original period approved 3. Approved items of production. 4. Action taken for setting up of unit: (a) Land acquisition (b) Loan sanction : Amount , date & Name of Financial Institution (c) Amount disbursed so far (Institution wise) (d) Equipment available on site : (i) Details of acquired Capital Goods (CG) imported with date and value (ii) Details of acquired indigenous CG with date and value (iii) Details of RM in stock and value (a) imported (b) indigenous Building construction: (e) Date of execution of legal undertaking : (f) Green card No. & period of its validity (g) Deleted (h) Date of Execution of B-17 bond (j) Power Connection (k) whether any SCN issued by local Customs/Central Excise Commissionerate : (l) if yes, the details thereof : (m) whether adjudicated or not : (n) Total up to date Investment and item thereof: (o) Details of Employment: 5. Likely date of commencement of production 6. Whether necessary permissions from state obtained (i.e. Pollution Control Board) 7 Details of all extensions given so far (along with the conditions mentioned therein) : 8 Reasons for non implementation so far: 9. Present request and reasons: 10.

. Pollution Control Board) 7 Details of all extensions given so far (along with the conditions mentioned therein) : 8 Reasons for non implementation so far: 9. Present request and reasons: 10. Proposed phasing of the project. 11. Specific Comments/categorical recommendation of the Development Commissioner Place:

Signature of the Applicant

Date:

Name in Block Letters

Designation

Official Full Official address

Seal/Stamp

Tel. No.

e-mail Address

Web-Site

Full Residential address

TeLe No

ANF-6C

APPLICATION FOR DTA SALE / ADVANCE DTA SALE PERMISSION

(Please see Paras 6.08 and 6.09 of FTP)

FOR THE PERIOD (QUARTERLY / HALF YEARLY / ANNUAL)

I. PROJECT DETAILS

Details of the unit

(i) Name & Address of the unit: (ii) IEC No. (iii) GSTN No.

LOI/LOP/IL No. & Date:

Details of the products approved for manufacture and export in the LOP/LOI/IL Item(s) of Manufacture/ Service Present installed capacity 1. 2. 3.

Date of commencement of production:

II. DETAILS OF ADVANCE DTA SALE

Details of advance DTA sale permitted, if any Approval No. and Date Particulars of products/ service permitted Value 1. 2. 3. Total

DETAILS OF DISPATCH UNDER PARA 6.08 (a),(d),(e)& (g) of the Chapter 6 of the Foreign Trade Policy

Details of DTA sale effected (Please indicate the period) Description of goods/service sold in DTA as DTA sale Value 1.

(a),(d),(e)& (g) of the Chapter 6 of the Foreign Trade Policy

Details of DTA sale effected (Please indicate the period) Description of goods/service sold in DTA as DTA sale Value 1.

Total

III. PRODUCTION DETAILS FOR THE APPLICATION PERIOD Gross production

I. Description of goods produced/manufactured/service Total Production including rejects and waste/scrap Quantity Ex-factory value 1. 2. Total

IV. DETAILS OF PHYSICAL EXPORTS FOR THE APPLICATION PERIOD

FOB value of Physical Exports Value of rejected consignment, if any Net FOB value of Physical Exports 1. 2 3. Total

V. NET FOREIGN EXCHANGE EARNINGS

NFE achieved on exports in the block period as per para 6.04 of FTP or less as applicable (Calculation Chart enclosed)

VI. PARTICULARS OF PROPOSED DTA SALE

Description of the items proposed to be sold in DTA Value 1. 2. 3. Total

DECLARATION I/We hereby declare that the information given above is true and correct Signature of the applicant Name Designation Seal of the Company CHARTERED ACCOUNTANT CERTIFICATE / COST ACCOUNTANT CERTIFICATE

We have checked and verified the figures mentioned above from the records and books of account of company and found them true and correct

Signature Name Membership No Seal

CERTIFICATE BY JURISTICTIONAL CUSTOMS/CENTRAL EXCISE AUTHORITY

Verified from the records and found correct by Inspector / Supdt.

them true and correct

Signature Name Membership No Seal

CERTIFICATE BY JURISTICTIONAL CUSTOMS/CENTRAL EXCISE AUTHORITY

Verified from the records and found correct by Inspector / Supdt. Of Central Excise & Customs I/C of the factory

Signature Name Seal

Note: Each page may be verified and signed by the Chartered Accountant/Cost Accountant Certificate.

CALCULATION CHART (TO BE CERTIFIED BY A CHARTERED ACCOUNTANT/COST ACCOUNTANT SHOWING NFE ACHIEVED IN THE BLOCK PERIOD AS PER PARA 6.04 OF FTP OR LESS AS APPLICABLE

DETAILS OF EXPORTS (Rs. in Lakhs) i) F.O.B. value of physical exports made in the block period as per para 6.04 of FTP or less as applicable Rs. ii) Value of supplies made under para 6.09 of the Chapter 6 of the Foreign Trade Policy Rs. iii) Total Rs.

DETAILS OF CAPITAL GOODS INCLUDING DG SET AND OTHER OFFICE EQUIPMENTS IMPORTED IN THE BLOCK PERIOD AS PER PARA 6.04 OF FTP OR LESS AS APPLICABLE

(I) CIF VALUE OF IMPORTED CAPITAL GOODS (YEAR WISE) IN THE BLOCK PERIOD AS PER

PARA 6.04 OF FTP OR LESS AS APPLICABLE

Ist year IInd year IIIrd year IVth Vth year Total

year

(II)VALUE OF IMPORTED CG PROCURED FROM ANOTHER EOU/SEZ UNIT OR FROM A LEASING COMPANY IN THE BLOCK PERIOD AS PER PARA 06.04 OF FTP OR LESS AS APPLICABLE Ist year IInd year IIIrd year IVth year Vth year VIth year

AMORTISED VALUE OF CAPITAL GOODS (Please see Note below for calculation) Rs.

DETAILS OF IMPORTED RAW MATERIAL (i) Total CIF value of imported raw materials, consumables including POL products and components etc. in the block period as per para 6.04 of FTP or less applicable Rs. (ii) Value of purchases made under Para 6.09 (b) &

para 6.13 (a) & (c) of Chapter 6 of the Foreign

Trade Policy in the block period as per para 6.04 of FTP or less applicable Rs. Iii) Value of goods indicated at (i) & (ii) above held in stock or under process at the end of the relevant period Rs. iv) Value of raw materials etc. used in goods produced and cleared from the unit {[(i) + (ii)]-[(iii)} Rs.

Total value of indigenous raw materials, consumables Rs.

components etc, used in goods produced and cleared from the unit in the block period as per para 6.04 of FTP or less as applicable

OTHER OUTFLOW OF FOREIGN EXCHANGE IN THE BLOCK PERIOD AS PER PARA 6.04 OF FTP OR LESS AS APPLICABLE

(i) Dividends Rs. (ii) Profit Rs. (iii) Technical know how fee Rs. (iv) Royalty Rs. (v) Commission Rs. (vi) Foreign travel Rs. (vii) Any other outflow in foreign exchange (Please indicate details) Rs. Total Rs.

NFE ACHIEVED

A - B> 0

Where A = FOB value of exports B = Sum total of value of imported inputs used. Proportionate (amortised) value of imported capital goods, technical know-how fee and other expenses made in foreign exchange

Note: The proportionate (amortized) value of imported capital goods and technical know-how fee shall be calculated as per the formula given in note (iii) of para 6.10 (d) of the Chapter 6 of the HBP.

Place:

Date:

Signature of the Applicant

Name in Block Letters

Designation

Official Full Official address

Seal/Stamp

Tel. No.

HBP.

Place:

Date:

Signature of the Applicant

Name in Block Letters

Designation

Official Full Official address

Seal/Stamp

Tel. No.

e-mail Address

Web-Site

Full Residential address

Tel. No

ANF-6D

APPLICATION FOR EXIT FROM EOU / EHTP / STP / BTP SCHEME

(Please see Para 6.18 of FTP)

Name & Address of the unit: 2. LOI/LOP/IL No. & Date: 3. Items of manufacture/service: 4. Date of commencement of production: 5. Date of completion of last five year block period 6. Copies of CA certified APRs for the period / year after completion of last five year block including for the current year) 7. Whether as per APRs (as per Sl. No. 6) the unit is NFE positive (attach calculation sheet separately) YES / NO 8. Legal Undertaking in the proforma in APPENDIX-6E YES / NO 9. Original LOP and Green Card / RCMC attached with the application YES / NO 10. ‘No Dues Certificate’ from Jurisdictional Customs/Central Excise Authorities attached with the application YES / NO 11. Whether any pending foreign exchange Realization; if so, details thereof YES / NO 12. Whether any CST reimbursement has been : availed for the raw materials/finished goods lying in stock at the time of exit, if so, details thereof (based on FIFO method) YES / NO 13. In case of Gems and Jewellery unit whether gold and other precious metals, alloys, gems and other materials available for manufacture of Jewellery have been handed over to nominated agency.

In case of Gems and Jewellery unit whether gold and other precious metals, alloys, gems and other materials available for manufacture of Jewellery have been handed over to nominated agency. If so, proof of the same may be attached. YES / NO 14. In case of pending appeal against order imposing penalty under FT(D&R) Act, whether bank YES / NO

guarantee for penalty has been furnished.

DECLARATION

I/We undertake to abide by the provisions of the Foreign Trade (Development and Regulation) Act, 1992, as amended from time to time, the Rules and Orders framed there under, the Foreign Trade Policy, the Handbook of Procedures and the ITC (HS) Classification of Export & Import Items. 2. I/We fully understand that any information furnished in the application if found incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted. 3. I/We hereby declare that the particulars and the statements made in this application are true and correct to the best of my/our knowledge and belief and nothing has been concealed or held there from. 4. I hereby certify that I am authorized to verify and sign this declaration as per Paragraph 9.06 of the Policy.

Signature of the applicant Name Designation Telephone No. Email id: Seal of the Company

DECLARATION BY THE CHARTERED ACCOUNTANT

I certify that information furnished in respect of Sl. No. 12 & 13 is correct as per records maintained by the company. Signature Name Membership No Seal

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