S.L. 336.2 Art. 4Fee due.

A processing fee of eleven euros and sixty-five cents (11.65) shall be paid by an applicant to the Department of Industry in respect of each application on the prescribed form filed with the same Department. Fees paid shall under no circumstances be refunded. SCHEDULE

(Regulation 3) LOCAL MANUFACTURES (PROMOTION) ACT (CAP. 336) Application for ad hoc Exemption from Levy

Applicant Name/Company Name: ........................................................... ...........................................................

........................................................... ........................................................... ..................... Fax No. ........................

Product/s (Description of items being imported) H.S. Code Estimated (Confirmed Quantity CIF Value by Customs)

(i) ................. .............. ........... ............ ................. .............. ........... ............ ................. .............. ........... ............

(ii) ................. .............. ........... ............ ................. .............. ........... ............ ................. .............. ........... ............

(iii) ................. .............. ........... ............ ................. .............. ........... ............ ................. .............. ........... ............

Section please attach a separate sheet if the space available is not

Remarks (State the reasons why an exemption is being requested). ...................................................................................................

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................................................................................................... Documents required Invoice No.: ..................................

Proforma Invoice No.: .................. Documents: ......................... A copy of an Invoice or Proforma Invoice of the consignment being to be submitted along with this application. Illustrated photographs/brochures/leaflets relating to the products Section 2 should also be submitted if requested by the Department of

............................. .............................. ....................... Signature and Full Name Date Identity Document Number