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Application No. | ||
Status |
Application No. |
To | ||||
The Director General, | ||||
Directorate General of Hydrocarbons, | ||||
(Under Ministry of Petroleum & Natural Gas), | ||||
Tower-A, Sector-73, | ||||
Noida - 201 301. | ||||
1. | Reference No : | |||
2. | ||||
3. | Name and address of Operator/Licensee/Contractor : | |||
4. | Sub-Contractor's Name & Address : | |||
5. | No. & Date of sub-contract by Operator (if any, copy to be attached) : | |||
6. | Supplier's Name and Address : | |||
7. | Ex-Works Address : | |||
8. | PO/SO placed by Operator/Sub-Contractor (copy to be attached) : | |||
9. | Call Out No., if any (copy to be attached) : | |||
10. | Technical Write-up with justification for present purchase : | |||
11. | If supply is under negative list, please attach permission from CCOE/DGFT/DGCA/AERB as the case may be : | |||
12. | Import Content, If Yes Value with EC (INR), without EC (INR) : | |||
13. | Particulars of Essentiality Certificate(s) already obtained for execution of the above contract (Statement is enclosed) : | |||
14. | Whether items of supply is by Operator on behalf of Joint Venture or in Individual Capacity or by Sub-Contractor : | |||
15. | Specified place/destination of use of items of present supply : | |||
16. | Office of the concerned Central Tax/State Tax commissionerate (Under Jurisdiction of recipient of outward supply of goods) : | |||
It is certified | ||||
(a) | ||||
(b) | that the present procurement is within the approved work programme and budget. | |||
DECLARATION/UNDERTAKING | ||||
1. | ||||
2. | ||||
3. | I/We will furnish to the Authorities necessary undertakings and affidavits as required in terms of the aforesaid Notification at the time of clearance of the goods. | |||
4. | I/We will comply with all policies, Hand-Book of Procedures and Public Notices issued from time to time. | |||
5. | I/We declare that the particulars and the statements made in this application are true and correct to the best of my/our knowledge and belief and nothing has been concealed or held there-from. | |||
6. | I/We will furnish a certified statement to DGH on end-use of all items procured for which ECs obtained in terms of above Notification on a yearly basis till such goods are finally utilised/consumed. | |||
7. | The present case is not an ex post facto case i.e. physical supply of materials will be effected only after obtaining EC from DGH. | |||
8. | I also declare that I am authorized to sign the application for the grant of exemption certificate. | |||
9. | I also undertake that Tax/Commercial Invoice will be in line with Performa Invoice. | |||
Date: |
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Place: |
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Seal |
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Notes |
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1. | Delete which ever is not applicable. | |||
2. | All pages of applications with List of Goods in duplicate, as per Format in Annexure-A, to be sealed & signed with date by the authorised signatory of the Operator/Licensee/Contractor. |
Annexure-A | ||
LIST OF GOODS | ||
1. | ||
2. | Operator's Name & Address : | |
3. | Sub-Contractor's Name & Address : | |
4. | Supplier's Name & Address : | |
5. | Ex-Works Address : | |
6. | Purpose of Goods : | |
7. | Currency Type : | |
8. | Purchase Order No. & Date : | |
9. | Call Out Order, if any : |
Sl. No. | Description of Goods | Sr. No. of List of Notification No. 3/2017 dated 28.06.2017 | PO No. | PO date | Invoice No. | Invoice date | Qty | UOM | Unit Rate(INR) | Total Value(INR) |
Discounts if any(INR) : |
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Total No. of Items : |
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GST |
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tdIGST |
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Annexure-A | ||
LIST OF GOODS | ||
1. | ||
2. | Operator's Name & Address : | |
3. | Sub-Contractor's Name & Address : | |
4. | Supplier's Name & Address : | |
5. | Ex-Works Address : | |
6. | Purpose of Goods : | |
7. | Currency Type : | |
8. | Purchase Order No. & Date : | |
9. | Call Out Order, if any : |
Sl. No. | Description of Goods | Sr. No. of List of Notification No. 3/2017 dated 28.06.2017 | PO No. | PO date | Invoice No. | Invoice date | Qty | UOM | Unit Rate(USD) | Total Value(USD) |
Discounts if any(INR) : |
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Total No. of Items : |
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GST |
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tdIGST |
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Exchange Rate |
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Sl. No. | Document Type | Document Name | Date |
Sl. No. | Query | Query Date | Response | Response Date | Attached File |
Application No. | Query | Query Date | Response | Attachment | Unique No. | Edit Application | Submit |
Notification Name : | ||
PO/Contract Type | PO CONTRACT |
To | |||||||
The Director General, | |||||||
Directorate General of Hydrocarbons, | |||||||
(Under Ministry of Petroleum & Natural Gas), | |||||||
Tower-A, Sector-73, | |||||||
Noida - 201 301. | |||||||
1. | Reference No : | ||||||
2. | |||||||
3. | Name and address of Operator/Licensee/Contractor : | ||||||
4. | Sub-Contractor's Name & Address : | ||||||
5. | No. & Date of sub-contract by Operator (if any, copy to be attached) : | ||||||
6. | Supplier's Name and Address : | ||||||
7. | Ex-Works Address : | ||||||
8. | PO/SO placed by Operator/Sub-Contractor (copy to be attached) : | ||||||
9. | Call Out No., if any (copy to be attached) : | ||||||
10. | Technical Write-up with justification for present purchase : | ||||||
11. | If supply is under negative list, please attach permission from CCOE/DGFT/DGCA/AERB as the case may be : | ||||||
12. | Import Content, If Yes Value with EC (INR), without EC (INR) : |
|
|||||
13. | Particulars of Essentiality Certificate(s) already obtained for execution of the above contract (Statement is enclosed) : | ||||||
14. | Whether items of supply is by Operator on behalf of Joint Venture or in Individual Capacity or by Sub-Contractor : | ||||||
15. | Specified place/destination of use of items of present supply : | ||||||
16. | Office of the concerned Central Tax/State Tax commissionerate (Under Jurisdiction of recipient of outward supply of goods) : |
|
|||||
It is certified | |||||||
(a) | |||||||
(b) | that the present procurement is within the approved work programme and budget. | ||||||
DECLARATION/UNDERTAKING | |||||||
1. | |||||||
2. | |||||||
3. | I/We will furnish to the Authorities necessary undertakings and affidavits as required in terms of the aforesaid Notification at the time of clearance of the goods. | ||||||
4. | I/We will comply with all policies, Hand-Book of Procedures and Public Notices issued from time to time. | ||||||
5. | "I/We declare that the particulars and the statements made in this application are true and correct to the best of my/our knowledge and belief and nothing has been concealed or held there-from." | ||||||
6. | I/We will furnish a certified statement to DGH on end-use of all items procured for which ECs obtained in terms of above Notification on a yearly basis till such goods are finally utilised/consumed. | ||||||
7. | The present case is not an ex post facto case i.e. physical supply of materials will be effected only after obtaining EC from DGH. | ||||||
8. | I also declare that I am authorized to sign the application for the grant of exemption certificate. | ||||||
9. | I also undertake that Tax/Commercial Invoice will be in line with Performa Invoice. | ||||||
Date: |
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Place: |
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Signatory User Name: |
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Notes : | |||||||
1. | Delete which ever is not applicable. | ||||||
2. | All pages of applications with List of Goods in duplicate, as per Format in Annexure-A, to be sealed & signed with date by the authorised signatory of the Operator/Licensee/Contractor. |
Select. | Description of Goods | Sr. No. of List of Notification No. 3/2017 dated 28.06.2017 | PO No. | PO date | Invoice No. | Invoice date | Qty | UOM | Unit Rate | Total Value |
Total No. of Items : |
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GST |
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IGST |
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Exchange Rate |
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Packing & Forwarding Charges: |
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Discounts if any(INR): |
Sl. No. | Document Type | Document Name | Date |
Document Name | Choose Document | Uploaded Documents |
Undertaking to DGH (Upto 2MB) | ||
Contract Copy & Call Out Order if issued or Purchase Order (Upto 15MB) | ||
Invoice
(Upto 2MB)
Tax/Commercial Proforma |
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Budget Certificate (Upto 2MB) | ||
Block Details (State should be mentioned) (Upto 2MB) | ||
Technical Justification (Upto 2MB) | ||
Affidavit & Undertaking (Upto 2MB) | ||
Others (Upto 2MB) |