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PEE SYSTEM ANNEXURE-V

DECLARATION-CUM-UNDERTAKING ON RS.10/- STAMP PAPER

I/We__________ ___________________ _____________ ___________partner/propreitor/director of M/s._______ _____________ _____________ _____________ do hereby solemnly declare that the goods to be exported by me/us under the PPE system have been sourced from the powerloom units in the SSI sector, as per the details given below :-
PPE quota certificate Shipping Bill No. & Date Country-category Description Quantity
-- -- -- --
(1) (2) (3) (4)



Name and full Factory address Of the supplier With Fax/Telex/Telephone No. No. and date of of Powerloom permit/acknow- ledgement issued by the State Govt./TX.C to the Supplier Supplier's invoice no. & date Details of payment made to the supplier
(5) (6) (7) (8)


I/We also hereby understand and undertake that if any of the information furnished hereinabove are not true, the PEE quota allotted will be cancelled, in addition to any other legal action that may be taken against me/us under the law(s) inforce.

Name & Signature of the

Partner/Proprietor/Director

Seal of the firm

Place

Date

Annexures
5












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