Annexure-1B

Form A-3

APPLICATION FORM FOR CENTRAL EXCISE REGISTRATION OF MANUFACTURERS OF HAND ROLLED CHEROOTS OF TOBACCO FALLING UNDER SUB-HEADING NO. 2402.00 OF CENTRAL EXCISE TARIFF ACT, 1985.

1.	Status of the Business (Please tick) c Sole proprietor c Partnership c Others
2.	Details of the business (i) Name : cccccccccccccccccccc (ii) Name and address of Proprietors/ Partners/ Other persons such as Directors, Authorised signatory: Name: cccccccccccccccccccc Address: cccccccccccccccccccc cccccccccccccccccccc Pin Code: cccccc (iii) Business address cccccccccccccccccccc cccccccccccccccccccc Pin Code: cccccc
3.	Permanent Account Number (PAN) (If given by Income Tax authorities or else leave blank) cccccccccc
4.	Excisable goods to be manufactured/ traded
5.	Major raw materials/ inputs used in manufacture of goods mentioned above
6.	DECLARATION I declare that the information given on this form is true and complete.

Signature & stamp:

(Full name in BLOCK CAPITALS)

cccccccccccccccccccc

Date

D  D      M  M    Y  Y  Y  Y
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Acknowledgement

(to be used if the Registration Certificate is not given at the time of receipt of the Application)

In accordance with your application for Registration, the Registration Certificate will be sent by mail at the address given at Serial No.1/ handed over personally on at ..(time).



[Name and Signature (with date) of the Central Excise Officer with Official Seal].

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Instructions for filling the form

1. At S. No.2, (i), Please give the name of the business.

2. At S.No.2 (ii), Full name and address of sole proprietor/ all the partners/ other persons such as directors/ company secretary or authorized signatory is to be stated.

3. At S.No.2 (iii), Please give the address of your principal place of your business. This is where you carry out your day-to-day running of the business.

4. In the declaration at S.No.6, for sole proprietor, proprietor should sign, for partnerships, one of the partners and for corporate bodies, a director, company secretary or authorized signatory must sign the form and the stamp affixed must be legible.

(Above Annexure 1B has been added vide NTF. NO. 81/2003-CE(N.T.), DT. 03/11/2003)