ANNEXURE-4

Declaration Form

To

The Assistant Commissioner/ Deputy Commissioner,
Central Excise,

I/We……………………………………….declare that to the best of my/our knowledge and belief the information furnished in the Schedule below is true and complete.

I/We undertake to apply for a Central Excise registration certificate in the proper form as soon as the value of the goods, mentioned in the said Schedule, cleared for home consumption in a financial year, reaches the full exemption limit.

I/We undertake to apply for a Central Excise Registration in the proper form as soon as the goods mentioned in the Schedule become chargeable to duty.

I/We undertake to maintain such records and follow such procedure as may be prescribed by the Commissioner in relation to the exempted goods.

I/We also undertake to intimate any change in the information furnished in the said Schedule.

THE SCHEDULE

1. Name(s) and address(es) of the proprietors/all partners/Directors of the company owning the factory.
   
2. Name and address of the factory.
   
   
3. Name and addresses of other factories/manufacturers (producing such goods) in whom the manufacturer claiming the exemption has proprietary interest.
   
   
4. Full description of the goods (heading-wise) manufactured by the factory.
   
   
5. Value/quantity of the goods cleared during the preceding financial year.
   
   
6. Value/quantity of the goods estimated to be cleared in the current financial year.
   
   
7. Heading No. or sub-heading No. of the First Schedule to the Central Excise Tariff Act, 1985 (5 of 1986) under which the goods are classifiable.
   
   
8. (a) Reference to the heading/sub-heading of the said Schedule Section 5A of the Central Excise Act, 1944 (1 of 1944), the case may be (under which the goods are exempted from the whole of the duty of excise leviable thereon).
   (b) Ground of exemption under the said heading/sub-heading or the said notification
   
   
9. Process of manufacture.

(SIGNATURE OF THE APPLICANT)

Note
:- Portion of the Form/Schedule that is not relevant to a particular manufacturer may be deleted