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Details of procurements relating to stocks of indigenous materials as on commencement to (the date three months prior to the date of supply/first supply)

No. Description Technical Characteristics S.No. in DBK-I statement Unit Qty purchased originally Assessable value Central Excise Tariff heading no.
1 2 3 4 4A 5 6 7

Effective rate of interest Amount of duty paid Name and address of supplier Invoice No. and date Is assessment of duty final Stocks as on _____ Remark

8 9 10 11 12 13 14


1. In this statement furnish details of stock of all the indigenous materials mentioned in statements I & III which were in stock three months prior to date of shipment/first shipment of the export product and how these were procured (including Invoices Nos.etc.).

1A.In this statement details of only those items which are chargeable to the Excise Duty may be given for which proof of payment of Central Excise duty can be established.

2. The particular of Invoice number, date etc. should be furnished in Column.11.

3. If the assessment which is not final or duty is paid under protest the extent of dispute may please be clearly indicated.

4. Refund applications made if any with details to be indicated.


Certified that the particulars mentioned in this statement are correct to the best of my knowledge and belief and no claims for refund of duty in respect of any of the above mentioned materials/components has been or will be lodged with the Central Excise Authorities.


Date Signature and Stamp of independent/

Chartered Accountant/
Cost Accountant Signature ________

(Name & Designation of the Chief Executive/ Production Incharge
(with seal)


The above information is a part of Online Training Course on howtoexportimport


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