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 (i) New declaration (ii) Amendments to declaration already filed (Pl. tick the appropriate box) 4. Declaration for the Financial Year ___________ *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 ___________ Place: Date: Name and signature of the officer with seal
