Form E.R.-1

(see Rule 12 of the Central Excise Rules,2002 and Rule 9(7) of CENVAT Credit Rules,2004)

Return of Excisable Goods and availment of CENVAT credit for the Month of ___________

RANGE

DIVISION

COMMISSIONERATE

Registration Number

Name of the Assessee

Details of the manufacture,clearance and duty payable:

CETSH NO.

DESCRIPTION OF GOODS

Unit of Quantity

Qty Manufactured

Qty Cleared

Assessable Valve (Rs.)

Duty

Notification availed

Sr.No.in Notification

Rate of Duty(Adv)

Rate of Duty(SPECIFIC)

Duty Payable(Rs.)

Education Cess payable(Rs.)

Provision Number

12(A)

Clearance details of inter unit transfer of intermediate goods without payment of Duty under

Sub rule(1) of rule 12BB

Reg No.of the recepient unit

Name & address of the sender primises

CETSH NO

Des.Of Goods sent

Unit of Qty.

Qty.Cleared

NOT APPLICABLE

Details of duty paid on excisable good:

Duty Code

Credit Account (Rs.)

Current Account (Rs.)

CHALLAN

BSR CODE

Total Duty Paid

Date

(2+3)

Cenvat

Edu.Cess 2 %

Service Tax

Other Duty

Edu.Cess 1 %

SERVICE TAX-DUTY DEBITED ON FINISHED GOODS RS.NIL + EDUCATION CESS RS.NIL + 1 % S & H EC RS.NIL

Receipt details of intermediate goods received from other premises under

Sub rule(1) of rule 12BB

Reg No.of the sender primises

Name & address of the sender primises

CETSH NO

Des. Of Goods received

Unit of Qty.

Qty.Cleared

NOT APPLICABLE

Abstract of Account-Current(Cash Payment)

Summary Particulars

Amount in

Amount in Rs.(BE

OP BAL

Add: TR-6/GAR-7 Challan payment made in the month(in Aggregate)

Add: Adjust of the excess duty paid during previous period under sub rute(2) 12bb(incase of LT)

Total Amount Available

Less: Utilization towards payment of duties on excisable goods during the month (vide details furnished under Col. No.3 in SI.No.(6) of the return)

Less: Utilization towards other payments made during the month (vide details furnished under Col. No.3 in SI.No.(9) of the return)

Closing Balance

Details of CENVAT credit taken and utilized

Details of Credit

Cenvat(Rs.)

AED(TTA)

NCCD(R

Ade leived under clasuse 85 of Finance Act 2005(Rs.)

Add Duty of customs levied under sec.3(5)of the custom Tarrif Act 1975

Ed.Cess on excisable goods

Service Tax

Ed.Cess on Taxable Services

Opening Balance

Credit taken on inputs on invoices issued by manufacturers

Credit taken on inputs on invoices issued by I or II stage dealers

Credit taken on imported Inputs

Credit taken on inputs on invoices issued by I or II stage dealers

Credit taken on imported Capital goods

Credit taken on Inputs services

Credit taken from inter unit transfer of credit by a large tax payer*

Credit taken under sub-rule(2) of rule 12BB of Central Excise Rule 2002*

Total Credit available

Credit utilised for payment of duty on Goods

Credit utilised when inputs or capital godds are removed as such**PURCHASE MATERIAL RETURN

Debited By Audit Party

Credit utilised towards inter-unit transfer of credit by a large tax payer

Closing Balance

Details of other payments made:

Payments

Amount Paid(Rs.)

Challan

BSR CODE

Source Doc

Account Curr

Credit Acc

No.

Date

(2-A)

(2-B)

(3-A)

(3-B)

Arrears of Duty under rule 8

Other Arrears of Duty

Interest payment under rule 8

Other Interest payment

Misc.Payment

Self Assessment Memorandum:

(a)

I hearby declare that the information given in this return is true,corrent and complete in every respect and that I am authorised to sign on behalf of the Assessee

(b)

During the Month,Total Rs.____

** was deposited vide TR-6 Challans No: GAR7(copies enclosed) E-PAYMENT MADE,COPY ENCLOSED

** Rs.________ BASIC EXCISE DUTY & RS.________ EDU.CESS 2% & RS._______1% S&H EDU.CESS

( c )

During the Month, invoices S.No,_____ to S.No_________ were issued

During the Month, Transfer challans under rule 12BB of the C E Rules,2002 bearing S No___ to____ and transfer challan under rule 12 A of the

Cenvat credit Rule,2004 bearing Sno ____ to ____ were issued.

FOR SAMEER LINKAGES PRIVATE LIMITED

PLACE:

DATE:

SAMEER SHAH

ACKNOWLEDGEMENT

(Name in capital letters and signature of the assessee or authorised signature)

Date of Receipt:____________

(DD MM YY

Name and Signature of the Range Officer with Official Seal