FORM ER-5 ,CENVAT Credit Rules, 2004

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FORM ER-5
{sub-rule (1) of rule 9A of CENVAT Credit Rules, 2004}
1. Name of the manufacturer:
2. PAN based Registration Number:
3. Annual Declaration
(i) New declaration
(ii) Amendments to declaration already filed
(Pl. tick the appropriate box)
4. Declaration for the Financial Year ___________
Sr. No. Description of principal inputs Central Excise Tariff Sub- HeadingNo. of principal inputs Quantity code* Description of finished goods in which principal input mentioned in column
(2) is used Central Excise Tariff Sub- Heading No. of finished goods Quantity code* Quantity of principal input mentioned in column  required for use in the manufacture of unit quantity of finished goods mentioned in column
*NOTE. - Please indicate the abbreviation referred to in Instruction No. 7 mentioned in Form
E.R.-1 and Form E.R.-3 specified in the Government of India, Ministry of Finance (Department of
Revenue) vide Notification No.25/2004-Central Excise (N.T.), dated the 27th September, 2004
published vide G.S.R.No.643 (E) dated the 25th September, 2004.
5. (i) I/We _________________hereby declare that the information given above is true,
correct and complete in every respect to the best of my/our knowledge and belief.
(ii) I/We am/are authorized to sign this declaration.
(Name in capital letters and signature
of the assessee or authorized signatory)
Place:
Date:
ACKNOWLEDGEMENT
Declaration for the Financial Year ___________
D D M M Y Y Y Y
Date of receipt
Place:
Date:
Name and signature of the officer with seal

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