ANNEXURE-A

Original/Duplicate/Triplicate/Quadruplicate

Range…………………………………….....Division……………………………………..

 

Application for removal of excisable goods from a factory or a  warehouse to another warehouse

 

 

            I/We holder(s) of Central Excise Registration No…………………………………… have undertaken to remove the under-mentioned goods from the factory/warehouse at…………………………….to the warehouse at………….………………..in Range ……………………….Division ……………………………..of Mr./Messrs……………….……holders of Central Excise Registration No …..……………………………………………………….……………………………………

 

Number and date of entry in ware-house register

 

 

 

 

Description of goods

No. and description of packages

Gross weight of packages

Marks and numbers on packages

Quantity of goods

Date of first ware-

housing

Value

Duty

 

 

Rate Amount

No. & date of invoice- (s) for removal of goods

Manner of transport

Remarks

1

2

3

4

5

6

7

8

  9          10

11

12

13

 

 

 

 

 

 

 

Rs. P.

Rs.P   Rs. P.

 

 

 

 

 

 

 

            I /We hereby declare the above particulars to be  true.

 

 

Place……..

Date………                                                                                   Signature of consignor(s) or his/their authorized agent.

 

 

                                                                                                                                                                                                     

 

 

Certificate of warehousing by the consignee

(on original and duplicate)

 

            I/We hereby certify that the consignment arrived at……………………….….on………………………...that the goods conform in all respects to the description given overleaf except for the following discrepancies, and that they have been warehoused under Entry No…………………………….of the register maintained in the ware house.

 

Particulars of discrepancies

 

No. and description of packages not received.

Quantity short received

Duty payable on the shortage

Remarks

1

2

3

4

 

 

 

 

 

 

 

 

 

Place……..

Date………..                                                                            Signature of consignee(s) or his/their authorized agent.