Ref. No.

APEDA/REGN Subject: Registration Procedure with APEDA Dear Sir, Please refer to your letter/E-mail/personal visit dated $indly arran!e to su%mit t#e follo"in! do&uments:'. ). -. 0. 3. 4. 5. Appli&ation form duly filled, sealed and si!ned %y aut#ori(ed si!natory. Self &ertified &opy of *mport-E+port &ode issued %y D.G.,.T. .ist of Dire&tors/Partners/Proprietor on &ompany/s letter#ead in tripli&ate.

DATED:

re!ardin! re!istration "it# APEDA.

Pvt. .td./Pu%li& .td. 1o./ s/so&ieties s#ould for"ard a &opy of t#eir 2emorandum and Arti&le of Asso&iation and Partners#ip firms s#ould for"ard a &opy of partners#ip deed attested %y Notary. Self &ertified &opy of PAN issued %y *n&ome Ta+ Department. T#e &ompany s#ould &ompulsorily mention t#eir e-mail *D, p#one and fa+ num%er et&. in t#eir appli&ation. *n &ase t#e e+porter desires to re!ister as Manufacturer Exporter, t#ey s#ould furnis# a self attested &opy of t#e re!istration of t#e &ompany "it# t#e relevant &ertifi&ation a!en&ies for t#e produ&ts !iven %elo":Products ,lori&ulture and seeds ,ruits 7 8e!eta%les/Ri&e/Groundnut/Pulses/ Guar!um/ 2is&. ,ood Preparations Pro&essed ,ruits 7 8e!eta%les/ Pro&essed ,ood Produ&ts/2eat produ&ts/1ereals preparation Dairy/Poultry/6oney Al&o#oli& :evera!es Certification Agencies Dept. of 6orti&ulture/D*1/S*A Deptt. 9f A!ri&ulture/ 6orti&ulture/D*1/ S*A/ ,SSA* ,SSA* ,SSA*/E*1/E*A Dept. of E+&ise 1ommissioner

;. =. '>.

:an< &ertifi&ate duly si!ned %y t#e Aut#orities. *n &ase of Re!istration of 2er&#ant E+porter for 2eat and 2eat Produ&ts please indi&ate t#e arran!ement made "it# manufa&turers "#ose produ&ts are to %e e+ported. 1as# or DD/Pay 9rder Rs. 3>>>/- to"ards re!istration may %e made in favor of APEDA paya%le to spe&ifi& APEDA offi&e "#ere t#e re?uest #as %een made for See<in! R121. @ours fait#fully Re!istration 9ffi&er

LIS !" APEDA !""ICES #EAD !""ICE Mr$ Man Pra%ash &ija' Assistant General 2ana!er A!ri&ultural and Pro&essed ,ood Produ&ts E+port Development Aut#ority N1A* :uildin!, -, Siri *nstitutional Area, Au!ust $ranti 2ar!, Ne" Del#i B ''> >'4 P#one: >''-)43'-)>0, )43'035), )43-0';4, )43'-)'=, )43-0'=' ,a+: >''-)43)4';5, E-mail: re!nCapeda.!ov.in Regiona( !ffice M)M*AI Mr$ Sudhanshu Re!ional *n&#ar!e A!ri&ultural and Pro&essed ,ood Produ&ts E+port Development Aut#ority 0t# ,loor, Anit No. - 7 0, :an<in! 1omple+ :ld!. No. **, Se&tor '=/A, 8as#i Ne" :om%ay-0>> 5>3 Telep#one: >))-)5;0>=0=/)5;0300)/)5;0>-3>/)5;0)>=0 ,a+: >))-)5;0))5E-mail: apedamumCapeda.!ov.in Regiona( !ffice +!L+A A Mr$ C$ *$ Singh Regional Incharge A!ri&ultural and Pro&essed ,ood Produ&ts E+port Development Aut#ority 2ayu<# :#avan, :id#an Na!ar, Salt .a<e 1ity $ol<ata-5>> >=' Telep#one: >---)--5;-4,a+: >---0>44=)=' E-mail: apeda<olCapeda.!ov.in Regiona( !ffice ,)-A#A I Mr$ *id'ut *aruah Regional Incharge A!ri&ultural and Pro&essed ,ood Produ&ts E+port Development Aut#ority !.s. road, 9pp. 9ld Post 9ffi&e, Dain 1omple+, -rd ,loor Gu"a#ati B 5;' >>3 Tel/,a+: >-4'-)3==>'> 2o%ile: =;40>-);=>; Residen&e: >-='-)4---=> E-mail: apeda!"#Capeda.!ov.in Regiona( !ffice #.DERA*AD Mr$ /agpa( Chir%utrao Loha%are Regional Incharge A!ri&ultural and Pro&essed ,ood Produ&ts E+port Development Aut#ority ;t# ,loor, 1#andra 8i#ar :uildin!, 2.D. Road, 6ydera%ad B 3>> >>' Telep#one: >0>-)0503=0> ,a+: >0>-)0503=05 E-mail: apeda#ydCapeda.!ov.in Regiona( !ffice *A/,L!RE Mr$ P$ P$ -agh0are Regional Incharge A!ri&ultural and Pro&essed ,ood Produ&ts E+port Development Aut#ority ')/'/', Pala&e 1ross Road, :an!alore B 34> >)> Telep#one: >;>-)--0-0)3/)--4;)5)

,a+: >;>-)--4034> E-mail: apeda%lrCapeda.!ov.in

AGRICULTURAL AND PROCESSED FOOD PRODUCTS EXPORT DEVELOPMENT AUTHORITY

E2inistry of 1ommer&e 7 *ndustry, Govt. of *ndiaF

"!RM1I
"!RM !" APPLICA I!/ "!R RE,IS RA I!/ C)M MEM*ERS#IP
To, Re!istration 9ffi&er APEDA, Dear Sir, $indly re!ister us 2er&#ant/2anufa&turer E+porter of t#e E+port Produ&tEsF mentioned in form ** at serial No. 3.
'. ). Name of t#e 1ompany : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG Address of t#e 1ompany : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG ERe!istered offi&e in &aseF : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG of .imited &ompanies, and : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG t#e #ead offi&e for ot#ers : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG -. Name 7 Address of t#e : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG :ran&#, if any 0. Name 7 Address of t#e ,a&tory 3. 4. 5. : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG

*E1 No. GGGGGGGGGGGGGGGGGGGGDate of issueGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG*ssuin! Aut#ority GGGGGGGGGGGGGGGGG PAN No. GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGDateGGGGGGGGGGGGGGGGGGG *f t#e re!istration is re?uired: No. GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGDate GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG As a manufa&turer e+porter SS* Re!istration *ndustrial .i&ense/*E2 '>>H E9A *ssuin! Aut#ority GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG 9t#er Espe&ifyF E6/T6/ST6/SST6/ EE+port 6ouse/Tradin! 6ouse/Star Tradin! 6ouse/Super Star Tradin! 6ouseF Golden 1ertifi&ate No. GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG8alid up to GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG EaF SE6/*SE6/*SSE6/*SSSE6 EServi&e E+port 6ouse/*nternational Servi&e E+port 6ouse/ *nternational Star Servi&e E+port 6ouse/ *nternational Super Star Servi&e E+port 6ouseF 1ertifi&ate No. GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG8alid up to GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG

;. =.

'>.

Details of Dire&tors/Partners/Proprietor/$arta to %e !iven in t#e follo"in! manner: E'F EaF E%F I Name ,at#er/s Name Resi. Address : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG EdF E)F EaF E%F I Telep#one Name ,at#er/s Name Resi. Address : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG EdF E-F EaF E%F I Telep#one Name ,at#er/s Name Resi. Address : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG EdF E0F EaF E%F I Telep#one Name ,at#er/s Name Resi. Address : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG EdF E3F EaF E%F I Telep#one Name ,at#er/s Name Resi. Address : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG EdF Telep#one : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG

''. ').

Name of E+port Produ&tEsF for "#i&# re!istration is re?uired : GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG */Je #ere%y solemnly de&lare t#at t#e a%ove stated information is true and &orre&t, */Je underta<e, "it#out any reservation, to : EaF E%F E&F EdF A%ide %y t#e terms of t#e re!istration &ertifi&ate !ranted to us on all our e+portsK A!ree to a%ide %y any &ode of &ondu&t t#at may %e pres&ri%edK A!ree to a%ide %y e+port floor pri&e &ondition t#at may %e stipulated %y t#e Re!isterin! Aut#orityK ,urnis# 9nline E+port performan&e "it#out fail ?uarterly i.e. April, Duly, 9&to%er and Danuary.

'-.

Je furt#er understand t#at our re!istration is lia%le to %e &an&elled in t#e event of %rea&# of any of t#e underta<in! mentioned a%ove. @ours fait#fully

ESi!nature "it# StampF Name Desi!nation Address Tele No. : : : . . ,a+ No. E-mail Address Res. Address : : : .. . .. . . :

Pla&e : Date:

AGRICULTURAL AND PROCESSED FOOD PRODUCTS EXPORT DEVELOPMENT AUTHORITY

E2inistry of 1ommer&e 7 *ndustry, Govt. of *ndiaF

"!RM1II
2See Ru(e 345

RE,IS RA I!/1C)M1MEM*ERS#IP CER I"ICA E

ETo %e filled in %y t#e appli&antF 3$ ). Name of t#e appli&ant E1ompany/s nameF Address of t#e appli&ant EiF Postal Address EiiF Tele!rap#i& Address EiiiF Address of fa&tory if any *ndi&ate "#et#er re!istration is re?uired in respe&t of EaF E%F E&F 0. 3. 3$ 6ead 9ffi&e Re!istered 9ffi&e :ran&# 9ffi&e : : : : : : : : : :

-.

Des&ription of t#e Produ&ts manufa&tured out of t#e follo"in!

Des&ription of t#e produ&tEsF for "#i&# Re!istration is re?uired from out of t#e follo"in!: Eti&< off "#i&#ever appli&a%leF "(oricu(ture 6 Seeds 1 ,lori&ulture 2 8e!eta%les Seeds 3 6er%al 7 2edi&inal Plants "ruits 6 &egetab(es 1 ,res# 9nions 2 9t#er ,res# 8e!eta%les 3 Dried Nuts EJalnutsF 4 ,res# 2an!oes 5 ,res# Grapes 6 9t#er ,res# ,ruits Processed "ruits 6 &egetab(es >' Dried 7 Preserved 8e!eta%les >) 2an!o Pulp >- Pi&<le 7 1#utney 4 9t#er Pro&essed ,ruits 7 8e!eta%les Ani0a( Products 1 :uffalo 2eat 2 S#eep/Goat 2eat 3 4 5 6 7 :$ 1 2 3 4 5 6 7 ;$ >' >) >>0 Poultry Produ&ts Dairy Produ&ts Animal 1asin!s Pro&essed 2eat Natural 6oney !ther Processed "oods 6PS Groundnuts Guar!um Da!!ery 7 1onfe&tionery 1o&oa Produ&ts 1ereal Preparations Al&o#oli& 7 Non-Al&#. :evera!es 2is&ellaneous Preparations Cerea(s Non :asmati Ri&e :asmati Ri&e J#eat 9t#er 1oarse Grains

7$

8$

9$

4.

Are you see<in! re!istration as EaF 2anufa&turer E+porter E%F 2er&#ant E+porter : : : :

5. ;.

@ear, 2ont# 7 Date of esta%lis#ment of t#e Appli&ant Name of Partners/Dire&tors/ 2ana!in! Dire&tors/Proprietor

*/Je #ere%y de&lare t#at t#e a%ove information is &orre&t to t#e %est of my/our <no"led!e and %elief. */Je also underta<e to a%ide %y t#e &onditions su%Le&t to "#i&# re!istration/mem%ers#ip is !ranted.

Si!nature "it# Stamp : Name in %lo&< letters : Desi!nation :

. . . .

Residential Address :

Date

*A/+ CER I"ICA E

S RIC L. PRI&A E 6 C!/"IDE/ IAL :an< :ran&# Ref. No. '. ). 3. Name of t#e 1ompany Addres : 1onstitution MPlease indi&ate EFN *ndividual Doint 6indu ,amily Proprietors#ip Partners#ip A/1 No. Date .. .. . . ... ..

0.

9t#ers Private .td. 1o. Name of Proprietor/Partners/Dire&tors/$arta 7 1o. o"ners of Doint 6indul ,amily. '. -.. 3. . ). 0. 4.

3.

Nature of a&&ounts in MPlease E8FN Savin! 1urrent @ears 1as# 1redit 9t#ers .No. of years .

4. 5. ;. =. -.

:an<in! Sin&e

:usiness/1ompany Esta%lis#ed/*n&orporation on EDate to %e indi&atedF Nature of :usiness a&tivity E2ain a&tivity of t#e ,irmF 9t#er Allied A&tivities Eif <no"n to t#e :an<F *f .imited 1ompany Aut#orised 1apital Rs. .. Paid up 1apital Rs. ''. 2eans of Proprietor/ Partners/Dire&tors

'). '0.

Name 7 Address of Asso&iate &on&ern of t#e firm Eif <no"n to t#e :an<F E+perien&e as to t#eir dealin!s: :rief Jrite Ap.

T#e :ran&# 2ana!er "it# 9ffi&ial Stamp