APPENDIX -23

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FORMAT OF CERTIFICATE OF CHARTERED ACCOUNTANT/
COST AND WORKS ACCOUNTANT
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I/We hereby confirm that I/We have examined the prescribed registers
and also the relevant records of M/S________________ for the
period ________ and hereby certify that:

(i) M/S._____________________ (fll name and address of the
applicant) have made the follo!ing exports in the
preceding three licensing years:

"ear #xport prodct $%& vale
''''' '''''''''''''' '''''''''''

(ii) (he follo!ing docments/records have been frnished by the
applicant and have been examined and verified by me/s
namely :'

#xport order/ )ontract* shipping bills* &ill of +ading (and/
or ,ir!ays &ills/ -eceipts). )stoms/ &an. attested
Invoices* &an. )ertificates of exports sho!ing exports made
and export proceeds realised in freely convertible crrency
in their o!n name and connected boo.s of acconts.

(iii) (he relevant registers have been athenticated nder my/
or seal/signatre.
(iv) (he financial information given in the above statement
is in agreement !ith the relevant register and records/
the same has been incorporated in the boo.s of acconts
maintained by the exporter/ and is also tre and correct.
(v) It has been ensred that the information frnished is
tre and correct in all respect/ no part of it is false
or misleading and no relevant information has been concealed
or !ithheld/
(vi) 0either I* nor any of my partners/director is a partner*
director* or an employee of the above'named entity or its
associated concerns/
(vii) I/We flly nderstand that any statement made in this
certificate* if proved incorrect or false* !ill render me/s
liable for any penal or other conse1ences as may be
prescribed in la! or other!ise !arranted.
(viii) I/ We certify that M/s 2222222222 have made exports
(directly or throgh third party) and has reali3ed the
foreign exchange in its o!n name or the third party as the
case may be in the preceding three licencing years as per
the details given in the annexre to this certificate.

(Signatre and Stamp/Seal of the Signatory)

()hartered ,ccontant/)ost 4 Wor.s ,ccontant)

0ame of the Signatory:
5lace: $ll ,ddress:
6ate: Membership 0o.:
)ontact 0o. :
#'mail :

If any of the docments or record mentioned in item (ii) of the
certificate have not been maintained/ frnished* examined or verified*
they may please be specified belo!:'
7.
8.
9.
0ote: Wherever ), certificate has been specified in any paragraph
of the 5olicy/:andboo. (;ol.7)* ),/)ost and Wor. ,ccontant
)ertificate may be frnished by the applicant as per the 5erforma
given above.
,nnexre to the )ertificate of )hartered ,ccontant/ )ost and Wor.s
,ccontant
S.0o Shipping
&ills 0os
6ate of +et
#xport
6escription of
prodct
$%& vale (in
rpees)

0ote.
7. #ach page of this annexre is to be signed by the )hartered
,ccontant !ith his registration nmber.
8. (he annexre shall be re1ired to be frnished only !ith the
application for grant of %ne to $ive Star #xport :ose.
APPENDIX -23A
FORMAT OF CERTIFICATE OF CHARTERED ACCOUNTANT/COST AND
WORKS ACCOUNTANT FOR SERVICE PROVIDERS
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'''
I/We hereby confirm that I/We have examined the prescribed registers and
also the relevant records of M/S_______________________________ for the
period ________ and hereby certify that:
M/s _________________________________ (fll name and address of the
applicant) have earned the follo!ing foreign exchange from direct and
indirect sorces in the prescribed licensing year:
(he follo!ing docments/records have been frnished by the applicant for
services provided against 6irect/Indirect foreign exchange and have been
examined and verified by me/s.
In respect of direct foreign exchange earnings* !e have verified the
certified statements from the &an.er/ )hartered ,ccontant of $oreign
#xchange #arnings. In respect of indirect forex earnings dly certified by
)hartered ,ccontant sch as amont received from (ravel agents/(or
%perators* $oreign ,irlines for stay of )re! and )atering* <0 organi3ations
and 6iplomatic Missions and #ncashment )ertificate from athori3ed dealers
and others in terms of 6=$( 5olicy circlar no.>?/@A'8??8 dated 8B.78.7@@C.
7. (he financial information given in the above statement is in
agreement !ith the relevant register and records/ the same has been
incorporated in the boo.s of acconts maintained by the Service
provider/ and is also tre and correct.
8. It has been ensred that the information frnished is tre and
correct in all respect/ no part of it is false or misleading and no
relevant information has been concealed or !ithheld/
9. 0either I* nor any of my partners/director is a partner* director* or
an employee of the above'named entity or its associated concerns/
B. I/We flly nderstand that any statement made in this certificate* if
proved incorrect or false* !ill render me/s liable for any penal or
other conse1ences as may be prescribed in la! or other!ise
!arranted.

(Signatre and Stamp/ Seal of the Signatory)

()hartered ,ccontant/ )ost 4 Wor.s ,ccontant)

0ame of the Signatory :
5lace: ,ddress :
6ate: Membership 0o. :