FORM-I - Monthly return for removal of specified goods - Clean Energy Cess Rules, 2010

FORM-I Monthly return for removal of specified goods (See Rule 11) Name of Producer: Full address: Registration Number: Month: Description of specified goods: Quantity of specified goods removed during the month (in MT) Rate of cess per tonne (Rs. per tonne) Total cess payable as per billing (Rs.) Total cess paid (Rs.) Remarks Note: In case where a producer has obtained centralised registration under rule 3, he shall provide the above details in respect of each mine. I /we hereby solemnly declare that the information given in this return is true, correct and complete in every respect. (Name in capital letters and signature of the registered person or his authorised agent) ---x---