Annexure 24 Form of Declaration for availing Benefit of Rebate of Center. Excise Duty Paid on Materials used in Manufacture and Packing of Export Goods (To be filed in Quintuplicate) To The Commissioner of Central Excise, ________________________ Sir, 1. We,_______________ (name of the manufacturer) having our officer at __________________and our factory at ___________ seek your permission to export materials used in the manufacture and packing of finished goods. 2. We are furnishing herewith details of finished goods to be exported and manufacturing formula with reference to quaintly/ proportion in which the materials are required for the finished goods & the tariff classification of materials and the duty payable the materials 3. We agree to abide by the provision of the Central Excise (No.2) Rules, 2001, notifications and any supplementary instructions issued in this regard; 4. We undertake to intimate any change in the consumption ratio within 10 days of such change. 5. We hereby declare (i) that we are not availing facility of input stage credit under CENVAT Credit Rules, 2001; (ii) that we shall export the finished goods without availing duty drawback of such duty; (iii) that the finished goods shall not be exported in discharged of export obligation under a Value Based Advance Licence or a Quantity Based Advance Licence issued prior to 31.03.95. (Signature) Seal Dated ____________________ Enclosed: 1. Write up on manufacturing Process 2. Statement of Input-Output Ratios 3. Ground Plan of the premises For use in Central Excise Office CERTIFICATE OF VERIFICATION I have visited the factory on ____________ and have verified the manufacturing process and the input/ output ratios. On the basis of the records maintained by the applicant, the write up on the manufacturing process, the flow diagram submitted be the application and physical verification of the manufacturing process, I find that the consumption of materials and wastage indicated in the Statement of Input-Output Ratios are in order. I have also verified the Quantity indicated in Column 5 of the Table to the Statement of Consumption does not include materials which is recycled in the process. or I find following difference in the Input-Output Ratios Claimed and actually observed. ______________________________ (Name) _________________________________ of Central Excise (Designation) SEAL DATE _______________________________