I. Are you a members of FKCCI(Required) Yes No I a. Please mention your Membership Number II. Name and address of the exporter with Telephone / Fax, Email, Website and year of establishment(Required)3. Name of the Contact Person and Designation with Mobile No & EmailIII. A. Contact Person(Required) III. B. Designation(Required) III. C. Mobile No(Required) III. D. Email(Required) 4. Name of the 2nd Contact Person and Designation with Mobile No & EmailIV A. Contact Person IV B. Designation IV C. Mobile No IV D. Email 5. Category of Exporters Please tick in Appropriate boxV. 1. Star Exporter Yes No V. 1a. Star Exporter (Export value should be above 500 crores) Manufacturing Merchant Services V. 2. Manufacturer Exporter Yes No V. 2b. Manufacturer Exporter (MSME definition as per MSME Act, GOI – Total Turnover - Micro <5 Cr, Small <50Cr: Medium <250 Cr, Large >250Cr) Micro Small Medium Large V 2c. Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.V. 3. Merchant Exporter Yes No V.3a. Merchant Exporter (Total Turnover - Small <50Cr: Medium <250 Cr, Large >250Cr) Small Medium Large V.3b.Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.V.4. Service Exporter Yes No V.4a. Service Exporter (excluding software) (MSME definition as per MSME Act) (MSME definition as per MSME Act, GOI – Total Turnover - Micro <5 Cr, Small <50Cr: Medium <250 Cr, Large >250Cr) Micro Small Medium Large V.4b.Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.V.4c. Software Exporter Yes No V.4d. Software Exporter (MSME definition as per MSME Act, GOI – Total Turnover - Micro <5 Cr, Small <50Cr: Medium <250 Cr, Large >250Cr) Micro Small Medium Large V.4e. Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.V.5. District Exporter(Required) Yes No V.5a. Name of District & Taluk V.6. Exporter in special category(Required) Yes No V.6a. please mention value addition/Innovation/technology upgradation in their exports V.6b. Debut Exporter(Required) Yes No V.6c .Year of establishment(Required) V.6e.Start-up Exporter (DIPP Certificate - Relevant Documentary evidence copy to be enclosed)(Required) Yes No V.6f. Relevant Documentary evidence – copy to be enclosedAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.V.6g.NMPT Exporter (Shipments effected through the New Mangalore Port Trust during 2022-23. Endorsement letter from NMPT is mandatory)(Required) Yes No V.6h.Is your organization - Export Facilitation Organization? If yes Central Govt. State Govt. Private V.6i. Is your organization - Financial Institution? If Yes Central Govt. State Govt. Private V.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 companyVI.IEC No. with the Date of issue(Required) VI.6a.Please Enclose Copy(Required)Accepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.VII. GST No.(Required) VII.a.Please Enclose Copy(Required)Accepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.VII.b. PAN No. VIII.Please Enclose CopyAccepted file types: jpg, gif, png, pdf, Max. file size: 4 MB.XI. CIN No. X. Details of Registration with Export Promotion Councils / Commodity Boards etc,X.a. 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 the guidelines).(Please tick the appropriate No.)(Required) 1 2 3 4A 4B 5 6A 6B 6C 6D 6E 6F 7 XIII. Note:(Required) 1. For category 6 A & B (Best Exporter Award in special category/ Best Debut Exporter), 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 6 D (NMPT Best Exporter Award), endorsement from NMPT is required14. FOB value of exports/Foreign exchange earnings in Crores FY 2022-23XIV.a. Total Turnover (INR in Crores) - FY 2022-23(Required) XIV.b. Total Exports (INR in Crores) - FY 2022-23(Required) XIV.c. Total Imports (INR in Crores) - FY 2022-23(Required) XIV.d. NFE Earned (INR in Crores) - FY 2022-23(Required) XIV.e. No. of Permanent Employees - FY 2022-23(Required) XIV.f. No. of Contract Employees - FY 2022-23(Required) XIV.g. Export Growth compared to last year - FY 2022-23(Required) XIV.h. FOB Value - FY 2022-23(Required) 15. FOB value of exports/Foreign exchange earnings in Crores FY 2021-22XV.a. Total Turnover (INR in Crores) - FY 2021-22(Required) XV.b. Total Exports (INR in Crores) - FY 2021-22(Required) XV.c. Total Imports (INR in Crores) - FY 2021-22(Required) XV.d. NFE Earned (INR in Crores) - FY 2021-22(Required) XV.e. No. of Permanent Employees - FY 2021-22(Required) XV.f. No. of Contract Employees - FY 2021-22(Required) XV.g. Export Growth compared to last year - FY 2021-22(Required) XV.h. FOB Value - FY 2021-22(Required) 16. FOB value of exports/Foreign exchange earnings in Crores FY 2020-21XVI.a. Total Turnover (INR in Crores) - FY 2020-21(Required) XVI.b. Total Exports (INR in Crores) - FY 2020-21(Required) XVI.c. Total Imports (INR in Crores) - FY 2020-21(Required) XVI.d. NFE Earned (INR in Crores) - FY 2020-21(Required) XVI.e. No. of Permanent Employees - FY 2020-21(Required) XVI.f. No. of Contract Employees - FY 2020-21(Required) XVI.g. Export Growth compared to last year - FY 2020-21(Required) XVI.h. FOB Value - FY 2020-21(Required) XVII.. Proposed target / planning for the year 2023-24(Required)XVIII. Mode of Export(Required) Seaport Airport Dryport XIX. If mode of Export is Seaport, please mention name of the port and quantum of ExportXX. If mode of Export is Airport, please mention name of the Airport and quantum of ExportXXI. If mode of Export is Dry Port, please mention name of the Dry Port and quantum of ExportXXII. Products / Services exported with HS Code (Harmonized System Code No.)(Required)XXIII. Countries to which Products / Services Exported(Required)XXIV.Any special achievements / New market development(Required)XXV. State / National / International / Other Export Award(s) Received, if any, please furnish detailsXXVI.A brief note or write-up for noteworthy value addition / Innovation / Technology up-gradation to substantiate, who are applying for Category 6A27. Please rank the below mentioned Export Facilitation Organization (TICK ANY 2)XXVII.a. DGFT Rank I Rank II Rank III XXVII.b. FIEO Rank I Rank II Rank III XXVII.c. VTPC Rank I Rank II Rank III XXVII.d. EEPC Rank I Rank II Rank III XXVII.e. STPI Rank I Rank II Rank III XXVII.f. State Commercial Tax Dept. Rank I Rank II Rank III XXVII.g. NMPT Rank I Rank II Rank III XXVII.h. Mangalore Customs Rank I Rank II Rank III XXVII.i. I & C Dept. Rank I Rank II Rank III XXVII.j. Bangalore Customs Rank I Rank II Rank III XXVII.k. Cochin SEZ Rank I Rank II Rank III XXVII.l. CFS, Bangalore Rank I Rank II Rank III XXVII.m. MSIL Rank I Rank II Rank III XXVII.n. CAPEXCIL Rank I Rank II Rank III XXVII.o. Container Corporation of India Rank I Rank II Rank III XXVII.p. Apparel Export Promotion Council (AEPC) Rank I Rank II Rank III XXVII.q. Any other Rank I Rank II Rank III XXIX.Self-Declaration:(Required) I Agree On behalf of my organization, I do hereby 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 in 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 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.
