Port Code SB No SB Date

INDIAN CUSTOMS EDI SYSTEM INCCU1 4215873 01-AUG-20

CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br 0289007089 1
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 21AABCG1428Q1ZO GSN
GOVERNMENT OF INDIA CB CODE AAACU5187HCH003
TYPE INV ITEM CONT
Nos 1 6 1
15/1 STRAND ROAD, CUSTOM HOUSE, KOLKATA - 700001 PKG 32 G.WT KGS 16540 * SB22050820200323

PART - I - SHIPPING BILL SUMMARY

1.MODE 2.ASSESS 3.EXMN 4.JOBBING 5.MEIS 6.DBK 7.ROSL 8.DEEC/DFIA 9.DFRC 10.RE-EXP 11.LUT
STATUS

SEA N Y N YY N N Y N
A

12.PORT OF LOADING INCCU1 (Calcutta) 13.COUNTRY OF FINALDESTINATION IRAN

14.STATE OF ORIGIN ORISSA 15.PORT OF FINAL DESTINATION IRBND (Bandar Abbas)
16.PORT OF DISCHARGEIRBND (Bandar Abbas) 17.COUNTRY OF DISCHARGE IRAN
1.EXPORTER'S NAME & ADDRESS 7.CONSIGNEE NAME & ADDRESS
EMAMI PAPER MILLS LIMITED CHEDEH KALA
B DECLARAN

BALGOPALPUR,P.O. RASULPUR ADDRESS: NO. 45 EAST HOVEIZEH,

DETAILS

PY
NORTH SOHREVARDI, TEHRAN, IRAN
BALASORE DISTRICT,ODISHA 2.Type Private IR
3. AD CODE: 6910004 8. GSTIN / TYPE 21AABCG1428Q1ZO GSN
4.RBI WAIVER NO.& DT 9.FOREX BANK A/C NO. 13XXXXXXXXXX693
5.CB NAME UNIWORLD LOGISTICS PVT LTD., 10.DBK BANK A/C NO. 51XXXXXX938
6.AEO 11. IFSC NO. SBIN0007502

CO
1.FOB VALUE 2.FREIGHT 3.INSURANC 4.DISCOU 5.COM 1.DBK CLAIM 2. IGST AMT 3.CESS AMT
SUMMA
E MANIFEST C.VALU

EX.PR.
671373.6 42780 0 0 0 8728 85696

D.
6.DEDUCTIONS 7.P/C 8.DUTY 9.CESS 4.IGST VALUE
0 0 714152
1.MAWB NO. 2.MAWB DT 3.HAWB NO. 4.HAWB DT N.O.C. 1.SNO 2.INV NO. 3. INV AMT. 4.CURRENC
DETAILS

1 F.INVOICE
10809585 714153.6 INR
SUMMARY
RT

1.CONTAINER 2.SEAL 3.DATE 4.S No 1SR.NO 2.CHALLAN NO 3.PAYMT DT 4.AMOUNT

CHALLAN DETAILS

GATU1285524 SPPL01163513 01-AUG-20 1

G. EQUIPMENT

PO
DETAILS

H
EX

1.SEAL TYPE 2.NATURE OF CARGO 3.NO. OF PACKETS 4.NO. OF CONTAINERS 5.LOOSE PACKETS
I. ANNEX
DETAILS

AGENCY SEALED CONTAINERISED 32 1 0

6.MARKS & NUMBERS
WE INTEND TO CLM REWARDS UND MEIS.EXPORTS FROM INDIA 2.53 EXPORT TO IRAN REALISATIONS
T

IN INDIAN RUPEES TO BE ELIGIBLE FOR FTP BENEFITS/INCENTIVE

LE

1.EVENT 2.DATE 3.TIME 4.LEO NO. 1/97

J.PROCESS

5.Submission 01-AUG-20 10:50 6.LEO Date. 04-AUG-20

DETAILS

5.Assessment 8.BRC Realisation Date 31-MAY-21

7.Examination 04-AUG-20 00:00
9.LEO 04-AUG-20 18:06

Signature Not Verified

Digitally signed by DS CENTRAL BOARD
OF INDIRECT TAXES AND CUSTOMS 02
Date: 2020.08.05 03:27:56 IST
Reason: CUSTOMS
Location: INDIA
Glossary
A: ASSESS - Assessed, EXMN - Examined, MEIS - Merchantise Export Incentive Scheme, DBK - Drawback, ROSL - Rebate of State Levies,
DEEC - Duty Exemption Entitlement Certificate, DFRC - Duty Free Replenishment Certificate,LUT - Letter of Under Taking. B: CB - Customs Broker
AD Authoized Dealer , AEO - Authorized Economic Operator, UCR - Unique Customs Reference C: DISCOU - Discount, COM - Commission,
P/C Packing Charges,D: EX. PR.- Export Promotions E: MAWB / HAWB - Master / House Airway Bill Number J:BRC- Bank Realisation Certificate

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Page 1 Of 7
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INCCU1 4215873 01-AUG-20
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br 0289007089 1
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 21AABCG1428Q1ZO GSN
GOVERNMENT OF INDIA CB CODE AAACU5187HCH003
TYPE INV ITEM CONT
Nos 1 6 1
15/1 STRAND ROAD, CUSTOM HOUSE, KOLKATA - 700001 PKG 32 G.WT KGS 16540 * SB22050820200323

PART - II - INVOICE DETAILS

1.S.No 2.INVOICE No. & Dt. 3.P.O.No. & Dt. 4.LoC No. & Dt 5.Contract No.&Dt 6.AD code 7.INVTERM
REF
A.

1 10809585 31/07/2020 6910004 CF

1.EXPORTER'S NAME & ADDRESS 2.BUYER'S NAME & ADDRESS
EMAMI PAPER MILLS LIMITED SAME AS CONSIGNEE

Y
BALGOPALPUR,P.O. RASULPUR `
B. TRANSACTION
PARTIES

756020

OP
3.THIRD PARTY NAME & ADDRESS 4.BUYER AEO STATUS

1.INVOICE VALUE

TC
2.FOB VALUE 3FREIGHT 4.INSURANCE5DISCOUNT6.COMMISON 7.DEDUCT 8.P/C 9.EXCHANGE RATE
C.VAL
DTLS

714153.6 671373.6 42780 0 0 0 0 1 INR INR 1

INR INR INR INR INR INR
1.ItemSNo 2.HS CD 3.DESCRIPTION 4.QUANTITY 5.UQC 6.RATE 7.VALUE(F/C)
1 48109200 WHITE COATED DUPLEX BOARD WITH GREY BACK 2332.8 KGS 45.25 105559.2
.S-300 GSM, Size: 60X90 cm LG.REWARDS UN D
OR
MEIS.E-SEAL.DTLS IN INV
2 48109200 WHITE COATED DUPLEX BOARD WITH GREY BACK 3024 KGS 45.25 136836
.S-300 GSM, Size: 60X100 cm LG.REWARDS U ND
MEIS.E-SEAL.DTLS IN INV
3 48109200 WHITE COATED DUPLEX BOARD WITH GREY BACK 2721.6 KGS 45.25 123152.4
.S-300 GSM, Size: 70X90 cm LG.REWARDS UN D
MEIS.E-SEAL.DTLS IN INV
4 48109200 WHITE COATED DUPLEX BOARD WITH GREY BACK 2520 KGS 45.25 114030
XP

.S-300 GSM, Size: 70X100 cm LG.REWARDS U ND

MEIS.E-SEAL.DTLS IN INV
5 48109200 WHITE COATED DUPLEX BOARD WITH GREY BACK 2419.2 KGS 45.25 109468.8
.S-300 GSM, Size: 70X120 cm LG.REWARDS U ND
MEIS.E-SEAL.DTLS IN INV
6 48109200 WHITE COATED DUPLEX BOARD WITH GREY BACK 2764.8 KGS 45.25 125107.2
TE

.S-300 GSM, Size: 80X120 cm LG.REWARDS U ND

MEIS.E-SEAL.DTLS IN INV
D. ITEM DETAILS

LE

Glossary
A: Ref - Reference P.O. - Purchase Order, LoC - Letter of Credit, AD - Authorised Dealer C: VAL DTLS - Valuation Details
FOB - Freight On Board, DEDUCT - Deduction , P/C - Packing Charge D: HS CD - Harmonized System Code, UQC - Unit Quantity Code

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Page 2 Of 7
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INCCU1 4215873 01-AUG-20
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br 0289007089 1
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 21AABCG1428Q1ZO GSN
GOVERNMENT OF INDIA CB CODE AAACU5187HCH003
TYPE INV ITEM CONT
Nos 1 6 1
15/1 STRAND ROAD, CUSTOM HOUSE, KOLKATA - 700001 PKG 32 G.WT KGS 16540 * SB22050820200323

PART - III - ITEM DETAILS

1INVSN 2ITEMSN 3.HS CD 4.DESCRIPTION 5.QUANTITY 6UQC 7.RATE 8VALUE(F/C) 9.FOB (INR) 10.PMV
1 1 48109200 WHITE COATED DUPLEX 2332.8 KGS 45.25 105559.2 99235.87 46.79
BOARD WITH GREY BACK .S-
300 GSM, Size: 60X90 cm
LG.REWARDS UN D MEIS.E-
SEAL.DTLS IN INV

PY
11.DUTYAMT 12.CESS RT 13CESAMT 14.DBKCLMD 15.IGSTSTAT 16. IGST VALUE 17. IGST AMOUNT 18SCHCOD
Y P 714152 85696 19
19. SCHEME DESCRIPTION 20. SQC MSR 21. SQC UQC 22. STATE OF ORIGIN 23. DISTRICT OF ORIGIN
Drawback 2332.8 KGS ORISSA BALESHWAR
24. PT Abroad 25.COMP CESS 26.END USE 27.FTA BENEFIT AVAILED 28. REWARD BENEFIT 29. THIRD PARTY ITEM

CO
NCPTI 0 INR GNX200 Y Yes N

1INVSN 2ITEMSN 3.HS CD 4.DESCRIPTION 5.QUANTITY 6UQC 7.RATE 8VALUE(F/C) 9.FOB (INR) 10.PMV
1 2 48109200 WHITE COATED DUPLEX 3024 KGS 45.25 136836 128639.08 46.79
BOARD WITH GREY BACK .S-
300 GSM, Size: 60X100 cm
LG.REWARDS U ND MEIS.E-
RT
SEAL.DTLS IN INV
11.DUTYAMT 12.CESS RT 13CESAMT 14.DBKCLMD 15.IGSTSTAT 16. IGST VALUE 17. IGST AMOUNT 18SCHCOD
Y P 714152 85696 19
19. SCHEME DESCRIPTION 20. SQC MSR 21. SQC UQC 22. STATE OF ORIGIN 23. DISTRICT OF ORIGIN
Drawback 3024 KGS ORISSA BALESHWAR
PO

24. PT Abroad 25.COMP CESS 26.END USE 27.FTA BENEFIT AVAILED 28. REWARD BENEFIT 29. THIRD PARTY ITEM
NCPTI 0 INR GNX200 Y Yes N
INVOICE (1/1)

1INVSN 2ITEMSN 3.HS CD 4.DESCRIPTION 5.QUANTITY 6UQC 7.RATE 8VALUE(F/C) 9.FOB (INR) 10.PMV
1 3 48109200 WHITE COATED DUPLEX 2721.6 KGS 45.25 123152.4 115775.22 46.79
BOARD WITH GREY BACK .S-
EX

300 GSM, Size: 70X90 cm

LG.REWARDS UN D MEIS.E-
SEAL.DTLS IN INV
11.DUTYAMT 12.CESS RT 13CESAMT 14.DBKCLMD 15.IGSTSTAT 16. IGST VALUE 17. IGST AMOUNT 18SCHCOD
Y P 714152 85696 19
19. SCHEME DESCRIPTION 20. SQC MSR 21. SQC UQC 22. STATE OF ORIGIN 23. DISTRICT OF ORIGIN
Drawback 2721.6 KGS ORISSA BALESHWAR
T

24. PT Abroad 25.COMP CESS 26.END USE 27.FTA BENEFIT AVAILED 28. REWARD BENEFIT 29. THIRD PARTY ITEM
NCPTI 0 INR GNX200 Y Yes N
LE

1INVSN 2ITEMSN 3.HS CD 4.DESCRIPTION 5.QUANTITY 6UQC 7.RATE 8VALUE(F/C) 9.FOB (INR) 10.PMV
1 4 48109200 WHITE COATED DUPLEX 2520 KGS 45.25 114030 107199.23 46.79
BOARD WITH GREY BACK .S-
300 GSM, Size: 70X100 cm
LG.REWARDS U ND MEIS.E-
SEAL.DTLS IN INV
11.DUTYAMT 12.CESS RT 13CESAMT 14.DBKCLMD 15.IGSTSTAT 16. IGST VALUE 17. IGST AMOUNT 18SCHCOD
Y P 714152 85696 19
19. SCHEME DESCRIPTION 20. SQC MSR 21. SQC UQC 22. STATE OF ORIGIN 23. DISTRICT OF ORIGIN
Drawback 2520 KGS ORISSA BALESHWAR
24. PT Abroad 25.COMP CESS 26.END USE 27.FTA BENEFIT AVAILED 28. REWARD BENEFIT 29. THIRD PARTY ITEM
NCPTI 0 INR GNX200 Y Yes N

GLOSSARY
FOB - Freight On Board, HS CD Harmonized System Code, UQC - Unit Quantity Code, PMV - Present Market Value, CESAM - Cess Amount
IGSTSTA - IGST Payment Status, VAL - IGST Value, PAID - IGST Amount Paid, SCHCOD - Scheme Code, SQC MSR - Standard Quantity
Measurement, comp - compensatory, PT Abroad - Preferential treatment Availed Abroad

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Page 3 Of 7
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INCCU1 4215873 01-AUG-20
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br 0289007089 1
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 21AABCG1428Q1ZO GSN
GOVERNMENT OF INDIA CB CODE AAACU5187HCH003
TYPE INV ITEM CONT
Nos 1 6 1
15/1 STRAND ROAD, CUSTOM HOUSE, KOLKATA - 700001 PKG 32 G.WT KGS 16540 * SB22050820200323

PART - III - ITEM DETAILS

1INVSN 2ITEMSN 3.HS CD 4.DESCRIPTION 5.QUANTITY 6UQC 7.RATE 8VALUE(F/C) 9.FOB (INR) 10.PMV
1 5 48109200 WHITE COATED DUPLEX 2419.2 KGS 45.25 109468.8 102911.3 46.79
BOARD WITH GREY BACK .S-
300 GSM, Size: 70X120 cm
LG.REWARDS U ND MEIS.E-
SEAL.DTLS IN INV

PY
11.DUTYAMT 12.CESS RT 13CESAMT 14.DBKCLMD 15.IGSTSTAT 16. IGST VALUE 17. IGST AMOUNT 18SCHCOD
Y P 714152 85696 19
19. SCHEME DESCRIPTION 20. SQC MSR 21. SQC UQC 22. STATE OF ORIGIN 23. DISTRICT OF ORIGIN
Drawback 2419.2 KGS ORISSA BALESHWAR
24. PT Abroad 25.COMP CESS 26.END USE 27.FTA BENEFIT AVAILED 28. REWARD BENEFIT 29. THIRD PARTY ITEM

CO
NCPTI 0 INR GNX200 Y Yes N

1INVSN 2ITEMSN 3.HS CD 4.DESCRIPTION 5.QUANTITY 6UQC 7.RATE 8VALUE(F/C) 9.FOB (INR) 10.PMV
1 6 48109200 WHITE COATED DUPLEX 2764.8 KGS 45.25 125107.2 117612.91 46.79
BOARD WITH GREY BACK .S-
300 GSM, Size: 80X120 cm
LG.REWARDS U ND MEIS.E-
RT
SEAL.DTLS IN INV
11.DUTYAMT 12.CESS RT 13CESAMT 14.DBKCLMD 15.IGSTSTAT 16. IGST VALUE 17. IGST AMOUNT 18SCHCOD
Y P 714152 85696 19
19. SCHEME DESCRIPTION 20. SQC MSR 21. SQC UQC 22. STATE OF ORIGIN 23. DISTRICT OF ORIGIN
Drawback 2764.8 KGS ORISSA BALESHWAR
PO

24. PT Abroad 25.COMP CESS 26.END USE 27.FTA BENEFIT AVAILED 28. REWARD BENEFIT 29. THIRD PARTY ITEM
NCPTI 0 INR GNX200 Y Yes N
INVOICE (1/1)

T EX
LE

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Page 4 Of 7
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INCCU1 4215873 01-AUG-20
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br 0289007089 1
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 21AABCG1428Q1ZO GSN
GOVERNMENT OF INDIA CB CODE AAACU5187HCH003
TYPE INV ITEM CONT
Nos 1 6 1
15/1 STRAND ROAD, CUSTOM HOUSE, KOLKATA - 700001 PKG 32 G.WT KGS 16540 * SB22050820200323

PART - IV - EXPORT SCHEME DETAILS

A. DRAWBACK & ROSL CLAIM

1.INV SNO 2.ITEM SNO 3.DBK SNO. 4.QTY/WT 5.VALUE 6.RATE 7.DBK AMT 8.REBATE9.AMOUNT 10.DBK+ROSL
1 1 4810B 2332.8 99235.87 1.3 1290.07
1 2 4810B 3024 128639.08 1.3 1672.31
1 3 4810B 2721.6 115775.22 1.3 1505.08
1 4 4810B 2520 107199.23 1.3 1393.59

Y
1 5 4810B 2419.2 102911.3 1.3 1337.85
1 6 4810B 2764.8 117612.91 1.3 1528.97
B. AA / DFIA LICENCE DETAILS

OP
1.INV SNO 2.ITEM SNO 3.LICENCE NO 4.DESCN OF EXPORT ITEM 5.EXP SNO 6.EXPQTY 7.UQC 8.FOB VALUE
9.SION 10.DESCN OF IMPORT ITEM 11IMP SNO 12IMPQT 13.UQC 14.INDIG / IMP

TC C. JOBBING DETAILS
1.BE NO 2.BE DATE 3.PORT CODE 4.DESCN OF IMPORTED GOODS 5.QTY IMP 6.QTY USED

D. SINGLE WINDOW DECLARATION

1.INVSN 2.ITMSN 3.INFO 4.QUALIFIER 5.INFO CD 6.INFO TEXT 7.INFO MSR 8.UQC
OTHER ADDITIONAL INFORMATION

1 1 CHR SQC 2332.8 KGS

OR

1 1 DTY GCESS 0 INR

1 1 ORC DOO 346
1 1 ORC EPT NCPTI
1 1 ORC STO 21
1 2 CHR SQC 3024 KGS
1 2 DTY GCESS 0 INR
XP

1 2 ORC DOO 346

1 2 ORC EPT NCPTI
1 2 ORC STO 21
1 3 CHR SQC 2721.6 KGS
1 3 DTY GCESS 0 INR
1 3 ORC DOO 346
TE

1 3 ORC EPT NCPTI

1 3 ORC STO 21
1 4 CHR SQC 2520 KGS
1 4 DTY GCESS 0 INR
1 4 ORC DOO 346
1 4 ORC EPT NCPTI
1 4 ORC STO 21
LE

1 5 CHR SQC 2419.2 KGS

1 5 DTY GCESS 0 INR
1 5 ORC DOO 346
1 5 ORC EPT NCPTI
1 5 ORC STO 21
1 6 CHR SQC 2764.8 KGS
1 6 DTY GCESS 0 INR
1 6 ORC DOO 346
1 6 ORC EPT NCPTI
1 6 ORC STO 21
E. SINGLE WINDOW DECLARATION - CONSTITUENTS
1.INVSN2.ITMSNO 3.C SNO 4.NAME 5.CODE 6.PERCENTAGE 7.YIELD PCT 8.ING

F. SINGLE WINDOW DECLARATION - CONTROL

1.INVSN2.ITMSNO 3.CONTROL TYPE 4.LOCATION 5.ST DT 6.END DT 7.RES CD 8.RES TEXT

Glossary
INVSN - Invoice Serial Number ITMSN - Item Serial Number A: DBK - Drawback, ROSL - Rebate of State Levies, B: DFIA - Duty Free Import
Authorization, EXP - Export , IMP - Import , UQC-Unit Quanity CodeFOB - Freight On Board D: INFO - Information CD - Code MSR - Measuremen
E: ING - Ingredient F : RES CD - Result Code, RES TXT - Result Text ST DT -Start Date G: IRN - Image Reference Number CD - Code PLA - Pla

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Page 5 Of 7
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INCCU1 4215873 01-AUG-20
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br 0289007089 1
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 21AABCG1428Q1ZO GSN
GOVERNMENT OF INDIA CB CODE AAACU5187HCH003
TYPE INV ITEM CONT
Nos 1 6 1
15/1 STRAND ROAD, CUSTOM HOUSE, KOLKATA - 700001 PKG 32 G.WT KGS 16540 * SB22050820200323

PART - IV - EXPORT SCHEME DETAILS

G.SUPPORTING DOCUMENTS
1.INVSN2.ITMSNO 3 DOCTYPCD 4. ICEGATE ID 5. IRN 6.PARTY CD 7.ISSUE PLA 8.ISS DT 9.EXP DT
1 1 380000 UNIWORLDKOL2 2020080100004710 INDIA 01-AUG-20
H.INVOICE DETAILS
1.SNO 2.INVOICE NO 3.INVOICE AMOUNT 4.CURRENCY

Y
1 10809585 714153.6 INR
I.CONTAINER DETAILS

OP
1.SNO 2.CONTAINER 3.SEAL 4.DATE
1 GATU1285524 SPPL01163513 01-AUG-20
J.AR4 DETAILS
1.INVSN 2.ITMSN 3.AR4 NUMBER 4.AR4 DATE 5.COMMISSIONERATE 6.DIVISION 7.RANGE

1.INVSN 2.ITMSN 3.IEC

TC K. THIRD PARTY DETAILS
4. EXPORTER NAME 5. ADDRESS 6.GSTN ID AND TYPE

L. ITEM MANUFACTURER/PRODUCER/GROWER DETAILS

1.INVSN2.ITMSN 3.TYPE 4.MANUFACT CD 5.SOURCE STATE 6.TRANS CY 7.ADDRESS
OTHER ADDITIONAL INFORMATION

OR
XP
TE
LE

Glossary
INVSN - Invoice Serial Number ITMSN - Item Serial Number A: DBK - Drawback, ROSL - Rebate of State Levies, B: DFIA - Duty Free Import
Authorization, EXP - Export , IMP - Import , UQC-Unit Quanity CodeFOB - Freight On Board D: INFO - Information CD - Code MSR - Measuremen
E: ING - Ingredient F : RES CD - Result Code, RES TXT - Result Text ST DT -Start Date G: IRN - Image Reference Number CD - Code PLA - Pla

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Page 6 Of 7
 Port Code SB No SB Date
INDIAN CUSTOMS EDI SYSTEM INCCU1 4215873 01-AUG-20
CENTRAL BOARD OF INDIRECT TAXES AND CUSTOMS IEC/Br 0289007089 1
DEPARTMENT OF REVENUE - MINISTRY OF FINANCE GSTIN/TYPE 21AABCG1428Q1ZO GSN
GOVERNMENT OF INDIA CB CODE AAACU5187HCH003
TYPE INV ITEM CONT
Nos 1 6 1
15/1 STRAND ROAD, CUSTOM HOUSE, KOLKATA - 700001 PKG 32 G.WT KGS 16540 * SB22050820200323

PART - V - DECLARATIONS

Y
OP
TC
A. DECLARATION STATEMENT

OR
XP
TE
LE
B. AUTHORIZED
SIGNATORY

DATE AUTHORIZED SIGNATORY CHA NAME :AAACU5187HCH003

PLACE

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Page 7 Of 7