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Range : HO.208,2NO Fl.'0' TYPE NOR11I DNo4AN Division: BlOO.SOMNATM Commissionerate:OJMI\II To. Superintend"'!tof Central Excise, Range : ri NOR11IIWioWC , ROaNNO.208,2ND TYPE R..'O' ~TM
1..Partlculars.of Asstll Dt!paty Commissioner of Cen~
Excise
A.R.E.-1
Application for Removal of Excisable Goods For EXPORT by [Air .'6"131Peat I Land) [ Rule 18 I Ru!e 19 of the Central Excise Rules. 2002 )
OUR A.R.I. f 110. fIIL.Df.IU
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Remarks
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LandI P~
, '
Amount
R.. No. and Date of Invoice under which
Particuiars f manufacturer o
'>
I'!egn, No.
Descnptionpf Packages
Quantity of Goods
, Desaiption
dutywas paid1No.
of Goods
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abov_tioned
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goods have been manufeetured, I TO,of c..nvet credO unde< Cenvat COIdO
Ru"",, Excise
(bJ
A.oi!;.,. "'..Hlli f without evamng facility unde< ";'fification 2112OO4-Cenfrol 6th September, 2004 issued under Rule 180fCentrai Exci.e Rules, 2002.
Hrs.
For
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4. 5.
Excise
dated'
export obligetion under a auanti!J[olfooadAdvence lioen~UnderCtaimofDutyOnl. . underCuOIOmsand Central Exci.e Duties OroWl>?"RuteS, 1995. lIWe herebydedarethe'the"""""particularsare trueand correctly stated,
I/We her"""'dare
in disohe rgehe
Signature 01owner Ofhis euthorised agent with date. Name in 8Iock letten; & Designalion (SEAl)
rIh AU[,t~
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