Annexure 9 Pass Out Document [For removal of Liquid gases in terms of rule 8] Serial No.______________ Original Duplicate Triplicate 1. Name & Address of the manufacturer _____________________________________________ 2. Registration Number ______________________________________________________________ 3. New ECC Number: 4. Range: ________________ Division: _____________ Commissionerate _________________ 5. Date of Removal--__________________ Time of Removal_________________ Part-I 6. Duty leviable on the Net Weight of goods despatched (calculated provisionally): Rs.___________________________________________________________________________________ (In words)(Rupees)____________________________________________________________________ Provisional Entry No. in Daily Stock Account____________________________________________ (1) Description of the goods and its Tariff Sub-Heading No. (2) Lorry Tanker Registration No. (3) Gross Weight of the loaded tanker at the time of despatch Kg. M3 (4) Tare Weight of Lorry Tanker Kg. (5) Net Weight of goods despatched [(3) - (4)] Kg. M3 Part-II (i) Supply Schedule Sl. Name Delivery Quantit Time Customer To be filled latest by N of the Note y of 's the next working day o. Custom No. Goods Signature of the return of Lorry er delivere Tanker in the factory d Kg. M3 In Out Invoic e No. & date Final Duty Entry No. in Daily Stock Accou nt 1. 2. 3. 4. 5. (ii) 1. Quantity of goods returned to factory in lorry tanker Kg. M3 2. Quantity of goods lost in transit & other losses, if any Kg. M3 I/we hereby solemnly declare that information above is true and correct in all respects. Signature of the Registered person or his authorised agent (iii) Undertaking I/We am/are taking clearance of the aforesaid goods under special procedure as per Commissioner of Central Excise permission F.No.__________________ dated _______ under a specific condition that any quantity not shown as delivered to the customer/consignees including the quantity attributable to all kinds of losses will be liable to full payment of duty by me/us. Accordingly, I/we hereby undertake that I/we will pay central excise duty on the entire quantity of such unaccounted goods including all types of losses at the highest effective rate prevailing on the date of removal of the consignment. Place Date Signature of the Registered person or his authorised agent
