ANNEXURE-55

CHALLAN FORM

Printed Serial Number

[See Rule 8A (iv)]

ORIGINAL- FOR BUYER
DUPLICATE- FOR SUBMISSION ALONGWITH QUARTERLY RETURN
TRIPLICATE-MANUFACTURERS OFFICE COPY

1. Name and address of the exempted weaver(manufacturer):

2. Declarant code: (12 digit code)

3. Date of issue;

1.	Name, address and central excise Registration No. of the manufacturer or supplier of yarn
2.	Invoice No./Nos & date/dates .(herein after called the said invoice/invoices) under which yarn/yarns, used in the manufacture of the unprocessed fabrics being removed under this challan, were received
3.	Description of yarns (the invoice No./Nos. of which is mentioned in number 2 above) with identification nos. or marks
4.	(a) Total Quantity (in Kgs./meters) of yarns received under the said invoice/invoices, (b) Total assessable value (in Rs.) of yarns received under the said invoice/invoices.
5.	(a) Total Quantity (in Kgs./meters) attributable to yarns used in the manufacture of the unprocessed fabrics being removed under this challan. (b) Total assessable value (in Rs.) attributable to yarns used in the manufacture of the unprocessed fabrics being removed under this challan.
6.	(a) Total amount of excise duty (in Rs.)paid on yarns received under the said invoice/invoices. (b) Total amount of excise duty (in Rs.) attributable to inputs used in the manufacture of the unprocessed fabrics being removed under this challan.*
7.	Nature of Processes carried out
8.	Name, address and registration No. of the manufacturer to whom the goods are being sent (i.e. traders or processors)
9.	Date and time of dispatch of fabrics
10.	Description of goods despatched
11.	Quantity (Kgs/meters) and value of fabrics dispatched
12.	Cumulative clearance value of fabrics (in 000 Rs.), inclusive of the clearances made under this challan of fabrics, during the financial year

* The amount shown against this column shall be available to the buyer of fabrics for availing CENVAT Credit under the CENVAT Credit Rules, 2002.

DECLARATION

It is hereby declared that-

(a) due central excise duty/additional duty of customs has been paid on the above inputs;

(b) the above mentioned quantity of inputs, having the value mentioned above, have been used in the manufactured of the fabrics being cleared under this challan and under the cover of invoice No. ----------- and dated---------------;and

(c) the correct amount of excise duty attributable to the yarn used in the manufacture of fabrics cleared under this challan has been shown against number 6(b) above.

(Signature of Proprietor/Partner/Authorised person)

(Above Annexure 55 has been vide NTF. NO. 54/2003-CE(N.T.), DT. 09/06/2003)