Annexure-21 INVOICE ORIGINAL DUPLICATE TRIPLICATE QUADRUPLICATE Invoice of goods liable to Central Excise Duty in India transmitted under Central Excise Seal to Nepal Invoice No. ______________ Date_____________ Range_____________ Division___________ Commissionerate _______________ from _______________ (factory/warehouse) by through the Border Post of._______________ (Merchant's Name) ______________________ Marks and numbers of packag es Marks and numbers of packages Numbers and descripti on of packag es Description of good with tariff classificatio n Net weight, value or quantit y Value (words and figures) Rate of duty Amount of duty paid or payabl e (In Words and figures) Number and date of document under which Central Excise Duty was paid or is payable Gross weight of packag es Number and date of railway receipt, if any 1) I/We hereby declare that the above-mentioned particulars are true and correctly stated and that the consignment of goods is intended for export to Nepal ______(place) and shall not be diverted en route to any other country. Signature of exporter or his authorised agent. Place: Date: (To be printed overleaf) 2) Certified that the above-mentioned packages have been identified by me and sealed with the Central Excise seal under my supervision. Signature and designation of the Officer of Central Excise. Running Serial No. Date: (to be given in red ink and encircled by the Border Examiner) 3) Certified that the above-mentioned consignment has been duly identified by me and has passed the Border Customs Post. (Running Serial number of the Border Check Post to be written in red ink prominently encircled) Signature and designation of the Indian Officer-in-charge of the Border Customs Postat__________. 4) Certified that the above-mentioned consignment/packages have been duly identified by me and have been received and accounted for in Nepal. Signature and designation (with official seal) of Nepalese Customs Officer. Check Post ____________
