I. Are you a member of FKCCI, if yes please mention your membership number(Required) Yes No Please mention your Membership Number II. Name and address of the exporter with Telephone / Fax, Email, Website and year of establishment(Required)III. Name of the Contact Person and Designation with Mobile No & EmailA. Contact Person(Required) B. Designation(Required) C. Mobile No(Required) D. Email(Required) IV. Name of the 2nd Contact Person and Designation with Mobile No & EmailA. Contact Person B. Designation C. Mobile No D. Email V. Category of Exporters (Please tick ✔️ in the appropriate box)1. Star Exporter(Required) Yes No Star Exporter (Export value should be above 250 crores and below 500 crores) Manufacturing Merchant Services 2. Manufacturer Exporter(Required) Yes No Manufacturer Exporter (MSME definition as per MSME Act, GOI – Total Turnover - Micro <5 Cr, Small <50Cr: Medium <250 Cr) Relevant Documentary evidence – copy to be enclosed) Micro Small Medium Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.3. Merchant Exporter(Required) Yes No Merchant Exporter (Total Turnover - Small <50Cr: Medium <250 Cr) Small Medium Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.4A. Service Exporter (excluding software)(Required) Yes No Service Exporter (MSME definition as per MSME Act, GOI – Total Turnover - Micro <5 Cr, Small <50Cr: Medium <250 Cr) Relevant Documentary evidence – copy to be enclosed Micro Small Medium Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.4(B). Software Exporter(Required) Yes No Software Exporter (MSME definition as per MSME Act, GOI – Total Turnover - Micro <5 Cr, Small <50Cr: Medium <250 Cr) Relevant Documentary evidence – copy to be enclosed Micro Small Medium Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.5. District Exporter(Required) Yes No Name of District & Taluk 6(A). Exporter in special category(Required) Yes No please mention value addition/Innovation/technology upgradation in their exports to developed countries 6(B). Debut Exporter(Required) Yes No Year of establishment 6(C). Start-up Exporter (DIPP Certificate - Relevant Documentary evidence copy to be enclosed)(Required) Yes No Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.6(D). NMPT Exporter(Required) Yes No Shipments effected through the New Mangalore Port Trust during 2023-24. Endorsement letter from NMPT is mandatory6(E) Is your organization - Export Facilitation Organization? If yes Central Govt. State Govt. Private 6(F) Is your organization - Financial Institution? If Yes Central Govt. State Govt. Private 7. Exporter Award (Women Entrepreneur)(Required) Yes No Highest Export performed by Women Entrepreneurs either individual or should have more than 51% of the shares in the company (furnish details)VI. IEC No. Date of issue (Please enclose copy)(Required) Please Enclose Copy(Required)Accepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.VII. GST No (Please enclose copy)(Required) Please Enclose Copy(Required)Accepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.VIII. PAN No:(Required) Please Enclose CopyAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.IX. CIN No. X. Details of Registration with Export Promotion Councils / Commodity Boards etc., (Please enclose copy of RCMC)Please enclose copy of RCMCAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.XI. Quantum of Imports related to Export BusinessXII. Category under which applied for FKCCI Awards (refer guidelines) (Please tick ( ✔️) the appropriate No.)(Required) 1 2 3 4A 4B 5 6A 6B 6C 6D 6E 6F 7 XIII. Note: 1. Documentary evidence endorsed by CA is essential 2. For category 6A, A brief note or write-up for noteworthy value addition/innovation/ technology up-gradation to substantiate. 3. For category 6D (NMPT Best Exporter Award), endorsement from NMPT is requiredXIV. FOB value of exports/Foreign exchange earnings in Crores for 2023-24Total Turnover (INR in Crores) - FY 2023-24(Required) Total Exports (INR in Crores) - FY 2023-24(Required) Total Imports (INR in Crores) - FY 2023-24(Required) NFE Earned (INR in Crores) - FY 2023-24(Required) No. of Permanent Employees - FY 2023-24(Required) No. of Contract Employees - FY 2023-24(Required) Export Growth compared to last year - FY 2023-24(Required) FOB Value - FY 2023-24(Required) XV. FOB value of exports/Foreign exchange earnings in Crores 2022-23Total Turnover (INR in Crores) - FY 2022-23(Required) Total Exports (INR in Crores) - FY 2022-23(Required) Total Imports (INR in Crores) - FY 2022-23(Required) NFE Earned (INR in Crores) - FY 2022-23(Required) No. of Permanent Employees - FY 2022-23(Required) No. of Contract Employees - FY 2022-23(Required) Export Growth compared to last year - FY 2022-23(Required) FOB Value - FY 2022-23(Required) XVI. FOB value of exports/Foreign exchange earnings in Crores 2021-22Total Turnover (INR in Crores) - FY 2021-22(Required) Total Exports (INR in Crores) - FY 2021-22(Required) Total Imports (INR in Crores) - FY 2021-22(Required) NFE Earned (INR in Crores) - FY 2021-22(Required) No. of Permanent Employees - FY 2021-22(Required) No. of Contract Employees - FY 2021-22(Required) Export Growth compared to last year - FY 2021-22(Required) FOB Value - FY 2021-22(Required) XVII. Proposed Target / planning for 2024-25:(Required)XVIII. Mode of Export *(Required) Seaport Airport Dryport XIX. If mode of Export is Seaport, please mention the name of the port and quantum of exportXX. If mode of Export is Airport, please mention the name of the port and quantum of exportXXI. If mode of Export is Dryport, please mention the name of the port and quantum of exportXXII. Product / Service exported with HS Code (Harmonized System Code No.)(Required)XXIII. Countries to which Products / Service Exported(Required)XXIV. Any special achievement / new market development(Required)XXV. State / National / International / Other Export Award(s) received, if any, please furnishXXVI. A brief note or write-up for noteworthy value addition / innovation / technology up-gradation to substantiate who are applying for category 6AXXVII. Please rank below mentioned Export facilitation Organization (TICK ANY 2)DGFT Rank I Rank II Rank III FIEO Rank I Rank II Rank III VTPC 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 Apparel Export Promotion Council (AEPC) Rank I Rank II Rank III Any other Rank I Rank II Rank III Self-Declaration:(Required) I Agree On behalf of my organization, I do here by declare that we shall fully abide by the rules and regulations of FKCCI Export Excellence Awards, I understand and accept that the decision of the Award Jury is final an all respects, and no corresponding email appeal will be accepted on Jury's decision. I also declare that the organization has faced no penal action during 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 hereby undertake that all the information provided by me in this application is factual and has been fully verified by me.