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ANNEXURE-C |
FORM A.R.-3A NO:152 |
Range V |
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Original |
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Divison MAKARPURA |
Duplicate |
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Application for removal of excisable goods from
a factory in India to |
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Triplicate |
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to 100% export oriented undertaking |
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Quartruplicate |
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I/We,holder(S) of Central Excise Registration
No.______________ in
Form ________________________ apply for leave to remove |
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the under mentioned goods from the factory at ____________________________,
to the 100% Export-Oriented undertaking of Mr./Messers |
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______________________________________________________________________________ |
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No.and date of entry in RG-1
register |
Description
of goods |
No. and
description of packages |
Gross weight
of packages |
Marks and
numbers on packages |
Quantity of
goods |
Value Rs. |
Duty |
Manner of
transport |
Remarks |
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Rate |
Amount Rs |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
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(1) To be entered by the consignor/owner or his
authorised agent in words and figures. |
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( 2 ) The aforsaid Mr./messers ________________________________, have executed a bond at destination in |
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Form B-16 Gen Surely/Security bearing No.________________________________________ for Ruppees _________ Lacs |
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(3) A certificate of Central Excise Officer at
Central Excise_______ in Form C.T.3 is attached I/We hereby declare the above
particulars to be true. |
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Place:__________________ |
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____________________________________ |
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Date:___________________ |
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(1) Certificate of Central Excise Officer at
factory of removal. |
Signature of Consignor(S)/Owners(S) or
"his/their authorised agent" |
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To, The Officer of Central Excise,in charge of
the 100% Export Oriented undertaking |
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I here by certify that the consignment
confirms in all respects to the description given above and I have permitted
removal under transport permit |
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Form G.S.No.___________ dtd ___________ |
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Place _____________ |
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Date ______________ |
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( 2 ) Certificer-in- charge of the 100% Export
Oriented undertaking Central Excisable
I/C of factory of removal. |
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I
here by certify that the consignment arrived at and that the goods confirm in
all respect to the description given above/overleaf/Except for all the
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discrepanies
and that they have been entered under Entry no._______ dated_______ of the
Raw Materials Account Register prescribed by the collector or |
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Central Excise. |
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Place _____________ |
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Officer-in-charges 100% Export |
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Date ______________ |
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oriented undertaking |
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