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APPENDIX IV
(Declaration to be filed in respect of goods for which drawback under S.S.Nos.
03.01,03.02, 04.01,04.02,04.03,07.01,07.02,07.03,08.01,08.02,08.03,09.01,09.02,09.03,16,01
16.02, 16.03,1,7.01,17.02,17.03,18.01,18.02,18.03.19.'01,19.02,19.03,20.0120.02,20.03,
20.06, 20.07,20.10,20.11,20.12,20.15,20.16,20.17,21.01,21.02,21.03,39..01,39.03,39.05,
39.06, 39.07,39.09,39.11,39.12,39.13,39.14,39.15,,39.16,3,9.18,39.19,39.20,39.24,39.25,
39.27, 39.29,40.06,42.01,42.02,42.05,42.06,42.07,42.10,42.12,42.14,52,.01,52.03,52.04,
52.05, 54.03,54.0454.05,54.06,55.01,55.02,55:03,55.04,55.05,56,04,58.01,58.02,58.03,58.04,
60.06, 60.10,61.02,61.05,61.0762.02,62.09,62.10,62.21,63.03,63.04,63.061,63.062,63.07,
63.08, 63.10,63.11,64.01,64.02,64.03,64.06,64.07,64.08,64.09,64.11,71.02,71.03,71.05,
73.03, 73.11,73.13,73.15,73.22,74.02,74.04,74.05,74.06,74.07,74.12,74.17,74.19,74.20,
74.24, 76.03,76.04,82.01,82.03,82.031,82.032,83.07,84.26,84.54,84.58,85.37,85.38,85.39,
85.40, 85.45, 85.120, 85.154, 87.45, 90.07, 94.01, & 95.08 has been claimed).
Shipping Bill Number & Date .....................
I/We__________________________ (Name of the
Exporter) do hereby declare as follows:-
1. ThatnoCENVATfacility has beenavailedforany of the inputsusedinthemanufactureof export
products; and
2. Thatthegoodsarebeingexportedunder bond 'orclaimforrebateof Central Exciseduty and a
certificate fromconcernedSuperintendentofCentralExcise,inchargeoffactoryofproduction,tothe
effect thatCENVATfacilityhasnotbeenavailedforthegoodsunderexport,isenclosed(Drawbackas
per schedule is applicable).
(Name, Address & Signature of the Exporter)
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