Application for permission to avail of the special procedure relating to pan masala and pan masala containing tobacco (Gutkha) (Appendix - I ) and Intimation of payment of duty (Appendix - II)

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..... Central Excise Rules, 2002) Name of the manufacturer : Address of the manufacturing premise: ECC No : Address of other premises manufacturing the same products: I/We manufacturer of pan masala or pan masala containing tobacco, residing at .........................taluka/tehsil .................. district .............. hereby apply to avail of the special procedure in respect o .....

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..... I/We further undertake that any addition or removal of the packing machine would be done under the physical supervision of the Central Excise Officer as per the procedure provided in the notification. 2. I/We hereby agree to abide by the provisions and conditions of the said notifications throughout .....

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..... me and address of the Bank and branch Amount of duty paid Copies of bank challans are enclosed ( ) Place: Date: Name, residential address and signature of manufacturers or his/their authorised agent - Forms Ta .....

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