Original Duplicate Triplicate Quadruplicate Application for removal of stainless steel patties/pattas manufactured under the special procedure Name of the Factory........ Address............. 1. I/We................manufacturer(s) of stainless steel patties/pattas residing at..................Taluka/Tehsil..........District... . and holder(s) of Central Excise Registration No. ....dated.....having been permitted to avail myself/ourselves of the special procedure contained in the notification issued under rule 15 of Central Excise (No.2) Rules 2001, in respect of my/our production and transactions in such stainless steel patties/pattas at the above-mentioned factory/factories hereby declare that I /we intend to instal and employ the cold rolling machines for the production of stainless steel patties/pattas during the year....in the manner indicated below, and the total sum payable by me/us in terms of the provisions laid down in the notification in respect of the said period are stated hereunder: 2. I/We tender herewith the sum of Rs.....(Rupees......only). The balance will be paid by me/us in monthly instalments. 3. I/We hereby declare that the particulars furnished herein are true and complete to the best of my/our knowledge and belief. 4. I/We apply for leave to remove from the above mentioned premises during the period from ....to.....any stainless steel patties/pattas manufactured in the said premises during that period. 5. I/We understand that the permission accorded to me/us for the year...is subject to my/our paying the balance amount as indicated in paragraph 2 above. No.of cold rolling Machines to be installed and employed Rate prescribed in Government of India Notification No. /2001- Central Excise dated Sum payable Total (1) (2) (3) (4) Place... Date... Signature of manufacturer or his authorized agent. To The Superintendent of Central Excise ...........Range ...........Division COUNTERSIGNED Place.... Date... Superintendent of Central Excise ...........Range ...........Circle. Statement of duty paid: (a) For payment in cash at....... Treasury State Bank of India Reserve Bank of India (To be filled in by the manufacturer or his authorised agent) Name of person tendering payment Particulars of payment Amount(in words as well as in figures) (1) (2) (3) Head of Account 038-Union Excise Duties- Stainless steel patties/pattas (b) Under the compounded levy scheme. Date....... Signature of the tenderer (To be filled in by the Treasury or Bank) CERTIFICATE Deposit Number......Date.....Received payment of rupees (in words)...... Signature of Treasurer or Accountant Agent or Manager (c) For payment through account-current: Title of Account of Ledger Number and date of entry Amount (in words as well as in figures (1) (2) (3) Place... Date.... Signature of the manufacturer or his Authorized agent. (d) For payment through T.R.5/Special Revenue Money Order Date of Payment T.R.5 No./Special Money Order Coupon No. Amount(in words as well as in figures) (1) (2) (3) Place..... Date.... Clearance allowed subject to fulfillment of the condition of deposits Superintendent of Central Excise Note: Delete the entries not applicable.
