Application for removal of excisable goods for export by (Air/Sea/Post/Land) - [See Rule 18/19 of the Central Excise Rules, 2002 read with Notification Nos. 19/2004-C.E. (N.T.) and 42/2001-C.E. (N.T.)]

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..... s) 1. Particulars of Assistant/Deputy Commissioner of Central Excise/Maritime Commissioner of Central Excise from whom rebate shall be claimed/with whom bond/undertaking is executed and his complete postal address. 2. I/We ........ of ..............propose to export the under-mentioned consignment to ........... (Country of destination) by Air/Sea/Land/Parcel Post under claim for rebate/bond/undertaking*. Particulars of Manufacturer of goods and his Central Excise Regis-tration No. No. and Description of packages Gross weight/ Net weight Marks and Nos. on packages Quantity of goods Description of goods Value Dut .....

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..... and correctly stated. Time of Removal.................................. Signature of owner or his Authorised agent with date. Name in Block Letters and Designation (SEAL) PART A Certification by Central Excise Officer 1. Certified that duty has been paid by debit entry in the Personal Ledger Account No. .........and/or CENVAT Account Entry No. . or recorded as payable in Daily Stock Account, on the goods described overleaf. OR Certified that the owner has entered into Bond No. ............ under Rule 19 of Central Excise Rules, 2002 with the........................... .[F. No.___________________], duly accepted by the Assistant Commissioner/Deputy Commissioner of Central Excise________on _________(Date). .....

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..... Inspector of Central Excise PART B Certification by the Officer of Customs Certified that the consignment was shipped under my supervision under Shipping Bill No. _______ dated _______by S.S./Flight No. ______which left on the_______ day of________ (Month)__________(year) OR Certified that the above-mentioned consignment was stuffed in Container No._____________________ belonging to Shipping Line_________________ based on the Let Export Order given on ____________day of________ (Month)__________year) on the Shipping Bill No.______ dated_______ and sealed by seal/one time lock No._______________ in my supervision and the container was handed o .....

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