a2 – Manthan

1. Name and address of the exporter with Telephone / Fax, Email, Website and year of establishment

2. Name of the Contact Person

*2. Contact Person

*2. Designation

*2. Mobile No.

*2. Email

3. 2nd Contact Person details (If Applicable)

3. Contact Person

3. Designation

3. Mobile No.

3. Email

Category of Exporters Please tick in Appropriate box

4. Manufacturer Exporter (select correct answer) Relevant Documentary evidence – copy to be enclosed

Micro

Small

Medium

Large

5. Merchant Exporter (select correct answer) with relevant documentary evidence and co-manufacturer details to be enclosed

Yes

6. Best Services Exporter Award (ITES) (Gold & Silver)

7. Best Services Exporter Award (IT) (Gold & Silver)

8. Manufacturer Exporter (Khadi & Village Industries category)

Yes

*9. Name of the District & Taluk

10. Please Specify

Most Backward

More Backward

Backward

11. Your Organization is Export Facilitation Organization? If Yes

Central Government

State Government

Private

12. Is your organizations is Financial Institution?

Central Government

State Government

Private

*13. IEC No. with the Date of issue - Please Enclose Copy

*14. GST No.

*15. PAN No.

*16. CIN No.

*17. Details of Registration with Export Promotion Councils / Commodity Boards etc, (please enclose copy of RCMC)

*18. Quantum of Imports related to export business

20. Note:

1. For category 6A & B (Best Exporter Award in special category/Best Debut Exporter), Documentary evidence endorsed by CA / Bank is essential.

2. For Category 6A, A brief note or write-up for noteworthy value addition / innovation / Technology upgradation to substantiate

3. For category 6 C (Best Exporter from More / Most Backward Taluk), please specify the Taluk (refer annexure to guidelines for details)

4. For category 6 D (NMPT Best Exporter Award), endorsement from NMPT is required

21. FOB value of exports/Foreign exchange earnings in Crores (FY 2017-2018)

*21.Total Sales (INR in Crores)

*21.Total Exports (INR in Crores)

*21.Total Imports (INR in Crores)

*21.NFE Earned (INR in Crores)

*21.No. of Permanent Employees

*21.No. of Contract Employees

*21.Export Growth rate compared to previous year

*21.FOB Value

22. FOB value of exports/Foreign exchange earnings in Crores (FY 2018-2019)

*22.Total Sales (INR in Crores)

*22.Total Exports (INR in Crores)

*22.Total Imports (INR in Crores)

*22.NFE Earned (INR in Crores)

*22.No. of Permanent Employees

*22.No. of Contract Employees

*22.Export Growth rate compared to previous year

*22.FOB Value

23. FOB value of exports/Foreign exchange earnings in Crores (FY 2019-2020)

*23.Total Sales (INR in Crores)

*23.Total Exports (INR in Crores)

*23.Total Imports (INR in Crores)

*23.NFE Earned (INR in Crores)

*23.No. of Permanent Employees

*23.No. of Contract Employees

*23.Export Growth rate compared to previous year

*23.FOB Value

*24. Proposed target/planning for the year 2020-21

*25. Mode of Export

Seaport

Airport

Dryport

26. If mode of Export is Seaport please mention name of the port and quantum of Export

27. If mode of Export is Airport please mention name of the Airport and quantum of Export

28. If mode of Export is Dry Port please mention name of the Dry Port and quantum of Export

*29. Products / Services exported with HS Code

*30. Countries to which Products / Services Exported

*31. Products / Services Imported with HS Code and Countries from which Products / Services Imported

*32. Any special achievements / new market development

33. State / National / International / Other Export Award(s) Received, if any, please furnish details

34. A brief note or write-up for noteworthy value addition / Innovation / Technology up-gradation to substantiate, who are applying for Category 6A

35. Please rank the below mentioned Export Facilitation Organisations

DGFT

Rank I

Rank II

Rank III

FIEO

Rank I

Rank II

Rank III

VITC

Rank I

Rank II

Rank III

EEPC

Rank I

Rank II

Rank III

STPI

Rank I

Rank II

Rank III

State Commercial Tax Dept.

Rank I

Rank II

Rank III

NMPT

Rank I

Rank II

Rank III

Mangalore Customs

Rank I

Rank II

Rank III

I & C Dept.

Rank I

Rank II

Rank III

Bangalore Customs

Rank I

Rank II

Rank III

Cochin SEZ

Rank I

Rank II

Rank III

CFS, Bangalore

Rank I

Rank II

Rank III

MSIL

Rank I

Rank II

Rank III

CAPEXCIL

Rank I

Rank II

Rank III

Container Corporation of India

Rank I

Rank II

Rank III

Any other

Rank I

Rank II

Rank III

36. Are you a member of FKCCI, If yes please provide your membership number:

*37. Self-Declaration:

On behalf of my organization, I do hereby declare that we shall fully abide by the rules and regulations of the FKCCI Export Excellence Awards. I understand and accept that the decision of the Award Jury is final in all respects, and no correspondence or appeal will be accepted on Jury’s decision.

I also declare that the organization has faced no Penal action during the last 2 years, nor any case is pending against any corporate or other statutory compliance failure, from any regulatory authority.

I confirm that my Organization is eligible to take part in this competition, and that all information and accompanying application documents furnished by me are correct to the best of my knowledge.

I am willing to provide additional details as and when required for the evaluation process. Further my organization also will be liable for disqualification from the evaluation process for any false declaration.

I Agree