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

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

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FORM ‘A’
(See paragraph 3 of the Appendix)
Application for refund of CENVAT credit under rule 5 of the CENVAT Credit Rules, 2004
(Refund relating to the given period i.e. quarter or month ________)
To
The Deputy Commissioner / Assistant Commissioner of Central Excise,
Sir,
I/We have exported, the final products or output services of under-mentioned description, value, quantity to _________ during the given period. I/We am/are not in a position to utilize the CENVAT credit of duty/service tax taken,-
(a) on inputs or input services used in the manufacture of final products cleared for export under bond or letter of undertaking;
(b) on input or input services used in providing output services exported without payment of service tax, and such credit being allowed under rule 3 of the CENVAT Credit Rules, 2004, for payment of duty in respect of final products cleared for home consumption or for export on payment of duty or for payment of service tax on output services during the given period. I/We request that refund of such credit for the given period may be granted. The following particulars/enclosures are being provided/enclosed by me/us for this purpose.
(A) PARTICULARS OF FINAL PRODUCTS OR OUTPUT SERVICES EXPORTED DURING
THE GIVEN PERIOD:-
(i) Description:-
(a) Final Products __________
(b) Output Services ________
(ii) Quantity (in units) in case of final products _________
(iii) Value:-
(a) Final products_______________________
(b) Output Services__________________________
(B) PARTICULARS OF INPUTS OR INPUT SERVICES USED IN THE MANUFACTURE OF
FINAL PRODUCTS OR USED IN PROVIDING OUTPUT SERVICES DURING THE
GIVEN PERIOD:-
(i) Description:-
(a) Inputs __________
(b) Input Services ________
(ii) Quantity (in units) in case of inputs _________
(iii) Amount of credit taken on:-
(a) Inputs__________________
(b) Input Services_______________
(C ) TOTAL TURNOVER DURING THE GIVEN PERIOD:-
(i) The value of all output services and exempted services provided, including value of
services exported:-
(ii) The value of all excisable and non excisable goods cleared, including the value of
goods exported:-
(iii) The value of bought out goods sold:-
(D) ENCLOSURES:-
(i) Copy of the relevant Shipping Bills or Bills of Export duly certified by the officer of
customs to the effect that the goods have in fact been exported (in case of final
products).
(ii) Copy of invoices.
(iii) Certificate from the bank certifying realization of export proceeds (in case of export of
output services).
(iv) Relevant extracts of the records maintained under the Central Excise Rules, 2002, the
CENVAT Credit Rules, 2004, or the Service Tax Rules, 1994, as the case may be,
evidencing taking of CENVAT credit, utilization of such credit in payment of excise duty
or service tax and the balance unutilized credit during the given period.
(E) AMOUNT OF REFUND CLAIMED:-
Rs (in figures and in words)_____________________________
I/ we opt for/ do not opt for the facility of the refund amount being credited directly in my /our
bank account details as furnished below
1) Account Number
2) Name of the Bank
3) Branch (with address)
I / We certify that the aforesaid particulars are correct and I / we am / are the rightful
claimant(s) to the refund of excise duty or service tax, as the case may be, due thereon which
may be allowed in my/ our favour.
I/We declare that no separate claim for rebate of duties or service tax in respect of
excisable materials used in the manufacture of the goods or output service covered by this
application has been or will be made under the Customs and the Central Excise Duties Drawback
Rules, 1971 or under claim for rebate under the Central Excise Rules, 2002 or the Export of
Services Rules, 2005.
I/We declare that we have not filed /will not file any other claim for refund under rule 5 for
the same quarter or month to which this claim relates. Signature and full address of the claimant (s) ___________________________________________________________________ Refund Order No. ____________ Date ____________________ The claim of Shri /Messrs. _______________ has been scrutinized with the relevant
Shipping Bills or Bills of Export/ invoices/ certificate from Bank certifying realization of export
proceeds and refund of Rs______________(Rs._________) is sanctioned.
Date__________
Deputy Commissioner / Assistant Commissioner of Central Excise___________
Forwarded to-
1. The Chief Accounts Officer, Central Excise, for information and necessary action.
2. The Commissioner of Central Excise __________________
Date_____________ Deputy / Assistant Commissioner of CentralExcise_______________________________________________________________________________ Passed for payment of Rs _________________(Rs.____________). The amount is adjustable under Head "0038-Union Excise Duties-Deduct Refunds/ 0044- Service tax-Deduct Refunds". Date___________ Chief Accounts Officer ____________________________________________________________________ Cheque No.___________dated_____________issued in favour of Shri/Messrs ___________________ for Rs _________ (Rs.__________ _). Date___________ Chief Accounts Officer ____________________________________________________________________ Received Cheque No. ________________ dated ________________ for Rs. _____________________ (Rs.______________). Dated_________________
Signature of claimant.

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