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Application for refund of CENVAT credit under rule 5 of the CENVAT Credit Rules, 2004

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..... redit Rules, 2004 as per the details below: S No Description Amount in Rs 1 Total value of the goods cleared for export and exported during the quarter. 2 Export turnover of the services determined in terms of Clause D of sub-rule (1) of rule 5. 3 Total CENVAT Credit taken on inputs and input services during the quarter. 4 Amount reversed in terms of sub-rule (5C) of rule 3 5 Net CENVAT Credit = (3) - (4) 6 Total value of all goods cleared during the quarter including exempted goods, dutiable goods and goods for export. 7 Export turnover of service .....

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..... 012 - CE (N.T) dated ____ June, 2012. (iii) I/ We am/ are the rightful claimant(s) of the refund of CENVAT Credit in terms of rule 5, the same may be allowed in our favour. (iv) I/ We declare that no separate claim for drawback or refund has been or will be made under the Customs and Central Excise Duties Service Tax Drawback Rules, 1995 or for claim of rebate under Central Excise Rules, 2002 or the Export of Services Rules, 2005 or under section 93 or 93A of Finance Act, 1994( 32 of 1994). (v) I/ We declare that we have not filed or will not file any other claim for refund under rule 5 of CENVAT Credit Rules, 2004, for the same quarter to which this claim relates. Date d d m m y y .....

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..... _______ (Rupees ______________________ ). The amount is adjustable under head 0038 - Union Excise Duties - Deduct Refunds/ 0044 - Service tax - Deduct Refunds . (ii) Amount credited to the account of the claimant as per the details below: Amount refunded Account Number Reference No of transfer Name of the Bank Address of the Branch Date d d m m y y y y Chief Accounts officer --------------------------------------- Notes: See Notification no. 27/2012 CE(NT) dated 18-6-2012 Old form upto 26-2-2010 Old form upto 17-6-2012 .....

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