FORM ER-5
{sub-rule (1) of rule 9A of CENVAT Credit Rules, 2004}
1.
Name of the manufacturer .....................................................
2.
PAN based Registration Number: .....................................................
3.
Annual Declaration
(ii) Amendments to declaration
already filed
(Pl. tick the appropriate box)
4.
Declaration for the Financial Year ___________
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Sr. No. |
Description of principal inputs |
Central Excise Tariff
Sub- Heading
No. of principal inputs |
Quantity code* |
Description of
finished goods
in which principal
input mentioned
in column (2) is used |
Central Excise Tariff
Sub- Heading No.
of finished goods |
Quantity code* |
Quantity
of Principal input mentioned in column (2) required
for use in he manufacture of unit quantity of finished goods mentioned in column (5) |
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*NOTE.
- Please indicate the abbreviation referred to in Instruction No. 7 mentioned
in Form E.R.-1 and Form E.R.-3 specified in the Government of India, Ministry
of Finance (Department of Revenue) vide Notification No.25/2004-Central Excise
(N.T.), dated the 27th September, 2004 published vide
G.S.R.No.643 (E) dated the 25th September, 2004.
5.
(i) I/We _________________hereby declare that the
information given above is true, correct and complete in every respect to the
best of my/our knowledge and belief.
(ii) I/We am/are authorized to sign this
declaration.
(Name in capital letters and signature
of the assessee or
authorized signatory)
Place: .......................
Date: ........................
ACKNOWLEDGEMENT
Declaration
for the Financial Year ___________
Date of receipt .....................................
Name and signature of the officer with seal