[OMITTED-

ANNEXURE-49

Form for claim of drawback under Rule 13

Customs Form No.................

To

The Assistant Commissioner of Customs
or Deputy Commissioner of Customs,
Drawback Department,
(Name & Address of the Customs House)

Sub: Drawback claim under Sec. 75 of the Customs Act, 1962

We wish to lodge this claim for Drawback of duty of Customs as per the details below together with copies of all the relevant documents:

1.	Shipping Bill No. & date	:
2.	Invoice No. & date	:
3.	Bill of Lading or Airway Bill No. & date	:
4.	Description and quantity of goods exported	:
5.	Drawback sub-serial No.	:
6.	F.O.B. value & present market value of goods	:
7.	Calculation of drawback claim (worksheet attached)	:
8.	Indicate whether the claim is as per brand rate	:
9.	Brand rate letter No. & date and its validity period	:
10.	Indicate particulars of Test report & Test Bond (wherever necessary)	:
11.	No. of enclosures*	:

DECLARATION

I, ________________________ , the applicant representing the exporter ______________________ do hereby declare that what is stated above is true to the best of my informatin and belief, I also declare that no drawback has been claimed earlier pertaining to and Shipping Bill No. ______________________ dated _______________ .

(Signature of the Applicant)

*Please attach a list of documents enclosed. refer Rule 13 of Customs and central Excise Duties Drawback Rules, 1995. ]

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