Exp Exporter
Exp Exporter
Exp Exporter
17/2019 Annexure-A
EXP FORM
(Submitted electronically by exporter)
Statutory declaration to be furnished by exporters under Foreign Exchange Regulation Act, 1947
before shipment of goods. An incorrect declaration constitutes offence under the said Act.
Detail of Export
ank
Invoice Value 12733.2
12733.2 0 0
CMT value (if applicable) 0
Terms of sale (firm contract/LC or
6. Consignment sale) LC-PEPCO/KKL/2020/03-10/08/20
Name & address of
7. PEPCO POLAND SP. ZOO
importer/consignee
8. Name of carrying vessel
Bill of Lading/Railway Receipt/Airway
9. Bill/Truck Receipt/ Post Parcel
Receipt
hB
Port of shipment/Post Office of
10. CHITTAGONG
dispatch
11. Land Custom Post
12. Shipment date
Name of the exporter (in block letter)
des
13. with address. 79400- KAIZER KNITWEAR LTD, NAYAPARA
CCI &E's Registration Number and
14. date of the exporter 79400
Sector (Public or Private) under which
15. the Exporter falls PRIVATE
gla
MD.JAKIR HOSSAIN
Date: Authorised Signature & Stamp
of the Exporter with date.
Certified that the above exporter(s)is/are known to us, that he/they is/are bonafide businessman/men in Bangladesh and that he/they
has/have made arrangements with us for the realisation of the export proceeds of the goods declared on this form within four months
from the date of shipment and that we are satisfied with the said arrangements. We have also satisfied ourselves about the bonafides
of the importers/consignees abroad and their credentials etc.
*We undertake to ensure that export proceeds against shipment on firm contract shall be received by us within the stipulated period
of four months. In the event of noncompliance due to reasons beyond our control we shall furnish to the Bangladesh Bank a full
explanation as to the reasons and circumstances resulting in our inability to comply.
*We undertake that in the event of nonrealisation of export proceeds against shipment on consignment sale within the stipulated
period of four months, we shall obtain from the exporter (s) and furnish to the Bangladesh Bank a full explanation as to the
circumstances resulting in nonrealisation. We further undertake that in the event of short realisation, we shall obtain from the
exporter(s) and furnish to the Bangladesh Bank a fully documented account sale certified by the consignees/Chamber of Commerce of
the country of import.
*(Strike out the portion not applicable and authenticate with initials).