ANNEXURE-01

Original
Duplicate

FORM A-1

REQUEST FOR CENTRAL EXCISE REGISTRATION

Complete this Form for Registration with the Central Excise Department under provisions of rule 9 of the Central Excise (No.2) Rules, 2001. For more information, refer to the said rules and relevant instructions.

PART - I. Identification of Business requiring registration (manufacturing, warehousing, dealer in CENVATABLE goods)

1. Legal Name of the Business
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2. Permanent Account Number (PAN)cccccccccc
   (Issued by the Income Tax Department) (Self-attested copy to be enclosed)

3. Specify (Tick the box): Manufacturer c Warehouse c Manufacturer’s Depot c Dealer c
4. Address of the Business

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ccccccccccccccccccccccccccccc PIN cccccc



Telephone Nos. 						Fax Nos.

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E-mail Address
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5. Define boundaries of the premises to be registered
6. Address of Head Office, if any
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ccccccccccccccccccccccccccccc PIN cccccc



Telephone Nos. 						Fax Nos.

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E-mail Address
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7. Name, designation and address of contact person/authorised person:

Last Name 			First Name 		Middle Name

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Designation
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Permanent Account Number (PAN) cccccccccc
(Issued by the Income Tax Department)

Address
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ccccccccccccccccccccccccccccc PIN cccccc



Telephone Nos. 						Fax Nos.

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E-mail Address
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PART – II. Registration number and other details of OTHER existing businesses

1. Specify (Tick the box): Manufacturer c Warehouse c Manufacturer’s Depot c Dealer c

2. Registration Number ccccccccccccccccc

3. Legal Name of the Business
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4. Address of the Business
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ccccccccccccccccccccccccccccc PIN cccccc



Telephone Nos. 						Fax Nos.

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E-mail Address
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Please furnish the aforesaid information for each of the other such factory(ies)/warehouse(s)/ dealer’s premise(s).

PART – III. Details of Proprietor/Partners/Directors and Managing Director

1. Individual’s-Permanent Account Number (PAN) ProprietorcPartnercDirector/Managing Directorc
cccccccccc

Last Name 			First Name 		Middle Name

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Address
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ccccccccccccccccccccccccccccc PIN cccccc

PART – IV. History

1. Has the applicant ever owned any business in the past? Yes c No c
A. Name of Business (es)
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B. Previous Permanent Account Number (s)(PAN) and/or Registration Number(s)/Declarant Code Number(s):
PAN cccccccccc
Registration Number cccccccccccccccccccccccccccccc

2. Address
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ccccccccccccccccccccccccccccc PIN cccccc



Telephone Nos. 						Fax Nos.

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E-mail Address
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3. Has any other manufacturing business(es) existed in the past on the premises for which the current registration for manufacturing is being sought?
Yes c No c If yes, provide the following details:

A. Legal name of Business
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B. Whether the said Business was registered or not with the Central Excise Department or was having Declarant Code Number?

Yes c No c Not Known . c

If yes, provide registration number(s)/Declarant Code(s) (Whether based on PAN or otherwise):

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PART – V. Major Excisable goods to be manufactured, warehoused or traded

1.____________________________ 2.__________________________ 3.________________________

Declaration

I hereby declare that the information given in this Form is true, correct and complete in every respect. I would like to receive the Registration Certificate (Tick appropriate box):

c By mail at the address specified at Sl.No. c of Part-I
c By Hand

Date:
Place:

(Name and Signature of the Applicant/authorised person with stamp)

Acknowledgement

I hereby acknowledge the receipt of your application for Registration. This is to inform you that you have been registered with the Central Excise Department and your Registration Number is
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This number has been allotted on the basis of the information furnished in your application. Your Registration Certificate will be provided within 7 working days from today.

Signature of the Superintendent/Inspector of Central Excise Officer
(with Name & Official Seal)

Document Locator Number ___________________
(To be mentioned on the Department’s copy for official purposes)

INSTRUCTIONS
1. Application has to be filed in duplicate and submitted in the Range Office having jurisdiction over the place of business.

2. Use separate Forms for separate registrations.

3. Acknowledgement and Registration Number shall be given instantly on the Original copy. The Registration Certificate will be given within seven working days.

4. In the Form, “Legal Name of Business” refers to the name appearing on the Permanent Account Number (PAN) card/letter issued by the Income Tax Department

5. The expression “Business” used in the Form shall mean manufacturing unit/depot of a manufacturer/warehouse/registered dealership for the purposes of CENVAT.

6. Attach separate sheets for furnishing any information if the space provided in the Form is not sufficient

7. If an authorised person signs this Form, her/his details shall necessarily be provided at serial number 7 of Part I.

8. This Form should also be used to notify the Department of any change in the information subsequent to registration.

9. Document Locator Number will be specified by Range office on duplicate copy for internal records.”;

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