ANNEXURE-19
Statement Regarding Export of Excisable goods Without payment of duty
(Rule 19)

Original
Duplicate

Statement for the month of ________, 2___.

5. Name of the Assessee:
6. Registration No.:
7. Address:
8. Details of Excisable goods manufactured and exported, proof of export, duty payment if case proof of export is not available within statutory time limit (Part-I to IV):-

Part-I

Details of removals for export in the current month

Serial No.	A.R.E. 1 Number and date	Amount of duty	Debit serial No. in bond account with date	Entry No. in Daily Stock Account	Whether proof of export received? If, yes, date of ‘Pass for Shipment Order’ by Customs	Details of any short-shipment and adjustment on bond account
1	2	3	4	5	6	7

Total Credit admissible: [Total of Column 3 minus duty on goods short-shipped (total of duty in column 6)]___________________
(To be filled only where bond is furnished)

Part-II

Details of Proof of export received for earlier quarter(s)

Serial No.	A.R.E. 1 Number and date	Amount of duty	Date of ‘Pass for Shipment Order’ by Customs	Details of any short-shipment and adjustment on bond account
1	2	4	5	6

Total Credit admissible: (Total of Column 3 minus duty on goods short shipped (total of duty in column 6) _______________(To be filled only where bond is furnished)

Part-III

Details of all the A.R.E.1 which have not been received by exporter with Pass for Shipment Order by the end of the month, relating to earlier months (but which are within statutory time limit)

Serial No.	A.R.E. 1 Number and date	Month to which it relates	Debit serial No. in bond account with date	Amount of duty
1	2	3	4	5

Part-IV

Details of all the A.R.E.1 which have not been received by exporter with Pass for Shipment Order by the end of the month within statutory time limit and duties were discharged by the exporter along with interest

Serial No.	A.R.E. Number and date	Amount of duty payable	Amount of duty payment		Amount of Interest (in cash/ PLA)	Date of duty and interest payment
			PLA/Cash	CENVAT Credit
1	2	3	4	5	6	7

Total Credit admissible: (Total of Column 4 and 5) ___________________
(To be filled only where bond is furnished)

Part-V
Abstract of bond
(Only where bond is furnished)

Details of bond	Opening Balance of credit	Total debits during month	Closing balance	Fresh admissible credit Total of credits admissible in Part-I, II and III

m) I/We declare that I/We have compared the above particulars with the records and books of my/ our factory/ warehouse and the same are true and correct to the best of my/our knowledge.

n) I/We have enclosed copies of TR-6 where duty and interest have been paid by cash.

o) The original copies of A.R.E 1s authenticated by Customs at the place of export are enclosed.

p) I/We am/are authorised to sign this document.

Place:
Date:

Name in capital letters and signature
of the assessee or the Authorised Signatory

ACKNOWLEDGEMENT

This is to certify that the original A.R.E.1 with certification by Customs authorities [Pass for Shipment Order] as indicated in Part-I and Part-II above have been received. There are ________ (indicate number) A.R.E 1s received. The total amount of credit indicated to be admissible in Part-I and Part-II is Rs. ________________________ (in word ____________________________________), may be taken by the exporter in the running bond account, subject to further verification by the Department.

The Department will discharge Bond only after verification.

Date Of Receipt___________

Signature and Official Seal of the Range Officer

Place:

For Use of Central Excise Office

Range Office or Office of the Bond Accepting Authority

On verification with reference to the information received from the Customs Authorities of the Port/Airport/Land Customs/Post Office Statement is found, -

(a) in order* OR
(b) not in order* – Action initiated under F.No._________________________

Signature and Official Seal of the Range Officer/competent Officer

OFFICE OF THE BOND ACCEPTING AUHTORITY

Proof of export given in this statement is hereby accepted.* OR

Action may be taken on file.*

* (Strike whichever is not applicable)

Signature and official seal the bond accepting authority

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