Application for refund of duty/interest

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..... of goods : 4. Name and address of (a) Importer : (b) Customs House Agent : (c) Applicant : 5. Refund Claim under : section 27(1)(a) /section 27(1)(b) of the Act. : 6. Ground of claim* : [*specify with details whether the claim is on account of reassessment of rates of duty/valuation, Shortage/Short-landing, Pilferage, appellate order, arithmetical/clerical error, any other ground (specify.] 7. Amount of refund claim : .....

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..... Survey report (n) Insurance claim settlement certificate (o) Catalogue/Technical Write-up/Literature (p) Bills for Freight/Insurance/Other charges (q) Certificate of origin (r) Any other document considered necessary in support of the claim (specify) (s)Total Number of (s) documents enclosed : 10. Any further details deemed necessary and relevant to the refund claim : 11. Whether any other refund claim filed/pending against the same Import/Export document (Bill of Entry, Shipping Bill etc.). If yes, give details. : Yes/No .....

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..... for Assistant Commissioner of Customs Date ACKNOWLEDGEMENT TO BE ISSUED TO THE APPLICANT FILE NO.................................... Refund claim of Mr./M/s........... . ...................for Rs... ... ..............against Bill of Entry/Post Parcel/Baggage Form/Shipping Bill No......... .......dated...... ......... received in complete manner on. ... ..........admitted for examination vide Customs Refund Registration No............................dated.............. ....... for Assistant Commissioner of Customs PAR .....

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