RAC-100C CA Raisins--Export Application for Cash Back Transmittal

INSTRUCTIONS FOR COMPLETING FORM RAC-100C

No cash adjustment payment will be made by the Raisin Administrative Committee for
free tonnage raisins exported until an application is received from the Packer. (7 U.S.C.
608(d) and 7 C.F.R. 989.67).
Packer must furnish all information provided for in the form except that specified under
"For RAC use only."
Varietal Type -

Use terminology specified in Section 989.11 of Raisin
Order No. 989 as amended.

Pack Stvle -

Specify the packed configuration of the cases shipped
such as "30 lb.," "48/15 oz." or "36/125 gm."

# Per Case -

Specify the net fruit weight per case.

No. Cases -

Specify the number of cases applied for as shipped
for the specified pack style.

Packed Weight -

Multiply the net weight per case (# Per Case) by the
number of cases shipped (No. Cases).

Total Packed Weight-

Add the computed packed weight for each pack style.

Natural Condition Weight -

Divide the Total Packed Weight by the shrinkage
factor as specified in the export replacement offer.

"Cash Back" Requested -

Multiply the Natural Condition Weight by the "Cash
Back" rate as specified in Exhibit A of the applicable
Export Replacement Offer.

Country -

Specify the final country of destination for this
shipment.

Exporterllmporter -

Specify the name of the Exporter/Importer to whom
the raisins were shipped.

Shipment Date -

Specify the date the shipment was made from the
packing plant.

Packer Reference No. -

Provide a reference number that has been used to
identify this shipment.

According to the Paperwork Reduction Act of 1995, an agency may_not conduct or sponsor, and a person is not required to
respond to a collection of information unless it displllys a valid OMB control number. The valid OMB control number for
thIS information collection IS 0581-0178. The time required to cOnyJletethis information collection is estimated to average
10 minutes per response, includinx the time for reviewing instructions, searchmg existing data sources, gathering and
maintaining the dilta needed, andcompleting and reviewmg the collection ofinJormation. The U.S. Department-of
Agriculture (USDA) p-rohibits discrimmation in all its programs and activities on the basis of race, colOr;nationaT origin,
age, disabifiiy, ana where applicable, sex, marital status, Jt11J'ilialstatus, parental status; religion, sexutU orientation,
genetic information, P!Jlitictil beliefs, reprisal, or because aU or part of an individual's mcome is derived from any public
assistance program INot aUp"rohi6ited bases app-Iyto aUP!o/:!,ants.) Persons with disabilities who require alJernative
means for communIcation Ofprogram information (Braille lor!:< rint, audiotape, etc.) should contact USDA's TARGET

~

Center at (202 720-2600 (vOIce and TDlJ). To lie a co
h,i;;i0 iliscrimination, write to USDA, Director, 0 Ice 0 Civil
l!lJ:..hts, 1400 'Pndependence Avenue, S. W Was-f:ington,if. C 20 50-9410 or caU (800) 795-3272 (voice) or (2~ 7il6382

(llJD). USDA is an equal opportunity provider ana employer.

EXPORT PROGRAM APPLICATION FOR CASH BACK
RAISIN ADMINISTRATIVE COMMITTEE
P.O. Box 5217
Fresno, CA 93755-5217

RAC -100C
Revised

12/06

Office of Management

Control No. 0581-0178

The undersigned Packer hereby requests a cash adjustment payment from the RAISIN ADMINISTRATIVE
COMMITTEE for the raisins exported pursuant to this application. It is understood that upon submission of all required
documents by the packer, the Raisin Administrative Committee will pay the cash adjustment applicable to the raisins
exported pursuant to the Export Replacement Offer in effect as of the date of shipment. This application is subject
to all provisions as set forth in the applicable EXPORT REPLACEMENT OFFER as approved by the RAISIN
ADMINISTRATIVE COMMITTEE and the SECRETARY.

VARIETALTYPE: NATURALS
Pack Style

# Per Case

No. Cases

Packed Weight

TOTAL PACKED WEIGHT
NATURAL CONDITION WEIGHT
SHRINKAGE ALLOWANCE
TOTAL PACKED WEIGHTB

0.93959

CASH BACK REQUESTED:
COUNTRY CASH BACK RATE:
COUNTRY:
EXPORT I IMPORTER:
SHIPMENT DATE:
PACKER REFERENCE NO.
(Must agree with Reference No. on Truck & Ocean Bills of Lading)

The making of any false statement or representations in any matter within the jurisdiction of any agency of the
United States, knowing it to be false, is a violation of Title 18, Section 1001, United States Code, which provides
for a penalty of a fine of $10,000 or imprisonment of not more than five years, or both.

PACKER:

FOR RAC use only:

Date:

By:

DATE:

Check No.

& Budget