FORM E.R. - 4 ORIGINAL / DUPLICATE
[See Rule 12(2) (a) of the Central Excise Rules, 2002 ]
	ANNUAL FINANCIAL INFORMATION STATEMENT FOR THE Financial Year _________.
	( All figure relating to value and amount to be given in Rs. ______________ lakhs )
1	Registration Number :
2	Name of the Assessee :
3	Details of Expenditure:
(i)	Details of inputs including packing material and components used for manufacture.
( a)	Total value of inputs including packing material and components used for manufacturing									Rs…….
	on which CENVAT credit aailed (value as per purchase invoice or import document excluding all taxes).
( b)	Total value of inputs including packing material used for manufacturing on which CENVAT credit									Rs…….
	not availed
( c)	Value of raw material including packing material and components consumed as per Profit & Loss A/c									Rs…….
(ii)	Value and Quantity of each major raw material consumed in the manufacture of goods.
		ITEM			QTY (Kgs)			VALUE (In Lacs)
		Stainless Steel
		Brass
		Aluminium
		Copper
		Mild Steel
( a)	Description of raw material…………………………………………… Raw Material 'A'
						QTY In Kgs		VALUE In Lacs
		Opening Stock of Raw Material
		(+) Purchase of Raw Material				As Per Enclosure		-1
		( - )Closing Stock Of Raw Material
		Raw Material Consumption
( b)	Please state description of final product {as mentioned at Sr.No. 4 (ii) below}, where the raw material is
	principally used
		Final Products Name						Chaper No
		Connector
		Coupling
		DBTF
		Base Metal Mounting & Fittings
(iii)	Details of other Expenditure ( Rs. In Lacs )
( a)	Total Inward Freight									Rs…….
( b)	Total Outward Frieght									Rs…….
( c)	Advertisement / Sales Promotion									Rs…….
( d)	Commission paid for sales of manufactured goods									Rs…….
( e)	Total R & D Expenditure									Rs…….
( f)	Wages									Rs…….
( g)	Power and Fuel									Rs…….
( h)	Other Expenses* { excluding (a) to (g) above}.									Rs…….
(iv)	Details of goods got manufactured by the assessee through job workers:
( a)	Whether goods are got manufactured through job worker ?								Yes / No	Yes
( b)	If yes, whether any raw material/inputs are supplied to job work ?								Yes / No	Yes
( c)	Whether any raw material/inputs are used by the hob worker which are not supplied								Yes / No	No
	by the assessee ?
( d)	Total amount paid by the assess to jobworker Rs. ____________________  (Rs. In Lacs)
4	Details Of Income :
(i)	Total sales value ( Gross ) as per Profit & Loss account Rs. _______________ (Rs. In Lacs )
(ii)	Value and quantity of each masjor manufactured finished goods sold
	Please mention description and Chapter sub-heading. Finished Good "A"
						Quntity ( Please specify the unit also)		Value ( Excluding   Taxes ) ( Rs. In Lacs )
		Opening Stock of Finished goods
		(+) Purchase of Finished goods  (NOS.)				EBCLOSURE - 2
		( - )Closing Stock Of  Finished goods
		Finished goods sold (NOS.)
(iii)	Details of trading activity { excluding inputs cleared as such as per Sr. No. (viii) below }
						Quntity ( Please specify the unit also)		Value ( Excluding   Taxes ) ( Rs. In Lacs )
		Opening Stock of Trading Goods
		(+) Purchase of Trading Goods				NOT APPLICABLE
		( - )Closing Stock Of  Trading Goods
		Trading Goods  sold
(iv)	Sales value of non-excisable and fully exempted goods									Rs…….
	(excluding the goods exported) cleared during the Financial Year.
(v)	Value of goods exported under Bond									Rs…….
(vi)	Value of goods exported under claim for Rebate									Rs…….
(vii)	Total value of sales of waste and scrap									Rs…….
(viii)	Value of input on which CENVAT credit has been avalied and cleared as such:									Rs…….
( a)	On payment of amount equal to the credit availed.									Rs…….
( b)	Without payment of any such amount to job worker (excluding the value of both the inputs as such									Rs…….
	or the inputs used in job worked goods, receivable back by the assessee from job worker).
(ix)	Total sales Tax paid									Rs…….
(x)	Details of other Income :
		SI.NO.	CATEGORY						AMOUNT (IN LACS)
		1	Warranty charges from buyers
		2	Advertisement/Marketing expenditure recovered from customers
		3	Handling, storage, packing and forwarding charges
		4	Pre-delivery inspection charges
		5	Product development, drawing, design and development charges
		6	Transportation charges received
		7	Erection and Commission charges received
		8	Technical, Engineering, Consultancy etc. charges received
		9	Other receipts/income (excluding (1) to (8) above
(xi)	total "Other Income" as per Profit & Loss Account									Rs…….
(xii)	Details of job work undertaken by the assessee for others:
( a)	Whether any such job work activity carried out by the assessee ?								Yes / No	Yes
( b)	whether job work done using own raw material/inputs (i.e. other then those supplied by								Yes / No	No
	the person for whom job-work is done).
( c)	Whether job work goods are cleared on payment of duty or without payment of duty:								Yes / No	No
( d)	Total amount of job work charges received during the Financial Year									Rs…….
5	CENVAT Credit Details:
						Credit Availed (Rs.)		Credit Utilized (Rs.)
		On Inputs
		On Capital Goods
		On Taxable Input Service
6
(i)	I/We ______________ declare that the particulars declared above have been comapred with the records and books
	of my/our factory/warehouse and the same are true and correct to the best of my/our knowledge.
(ii)	I/We  am/are authorized to sign this return.
	Place :						( Name in capital letters and signature
	Date :						of the assessee or authotized signatory )
	#
	Note: To given separately and distinctly for each major raw material consumed on the lines of
	SI.No. 3 (ii) (a) (1) of part II of the Schedule VI pertaining to section  211 of the Companies Act, 1956 ( 1of1956 ), i.e.
	each such raw material which in value independently accounts for 10 % or more of the total value of the raw materials
	consumed.
	*Other expenses include all expenses like interest, depreciation, other overhaeds as shown in Profit & Loss Account.
	@
	To be given separately and distinctly for each class of major finished goods sold i.e. each such finished goods which
	in value independently accounts for 10 % or more of the total value of the finished goods sold as carified in Note 3 to
	the para 3 of  Part II of the Schedule VI pertaining to section 211 of the Companies Act, 1956 ( 1 of 1956 ).
	Please enclose copy Profit & Loss Account and Balace Sheet.
	ACKNOWLEDGEMENT
	Annual Financial Information Statement For The Financial Year ___________________
	DD MM YYYY
	DATE OF RECEIPT
							Name and Signature of the officer with seal
	Place :
	Date :