ANNEXURE 71

Application for permission/extension of permission to work under Rule 16C of Central excise Rules, 2002
(PART I)

GENERAL INFORMATION

COMMISSIONERATE :

DIVISION :

RANGE :

1. Date of Application
2. Name of the Applicant and address of the Factory
3. R.C. No.
4. Description of the Commodity in respect of which permission is requested with Central Excise Tariff Classification
5. Whether the application is made for the first time or for extension of permission already granted; in case of application for extension of permission, please state the number of extensions availed so far specifying the periods.
6. Nature of testing involved (A separate sheet may be added if necessary)
7. Whether the commodity is in the nature of Prototypes which are sent for trial / development tests
8. Duration of testing period and return of the tested goods
9. Whether such processing facility is lacking/ inadequate in the applicants factory
10. Whether the absence of such facility is of temporary nature
11. Whether the particular type of tests, for which excisable goods are intended to be sent outside, cannot be conducted in the same factory on expiry of the temporary permission, if granted. If so, brief
12. Whether there is a possibility of transit loss; if so quote the per cent of transit loss
13. Whether after testing, the tested excisable goods will be returned to the factory of origin or otherwise
14. Name(s) of the Manufacturers / Processors and Address(es) with details of testing work entrused
15. Whether the Processor(s) is/ are registered with Central Excise Department; if yes, furnish R.C. No, Range Name, Division Name, Commissionerate Name under whose jurisdiction such Processor(s) is / are falling.
16. Any other relevant information or list of documents enclosed if any.

It is certified that, the information furnished above is true and correct to the best of my knowledge.

We/ I hereby undertake to pay appropriate Central Excise Duty, along with the interest payable, if any, as per the provisions of Central Excise Act, 1944 and the Rules made thereunder, on the goods cleared for job work in case of transit / processing loss or in case the goods are not received back within the stipulated processing period of 180 days.

Place :
Date :

Signature of the Assessee

(PART II)
(To be completed by the Superintendent of Central Excise in Charge of the Range)

1. The period for which the permission is recommended and whether in case of expiry of the said period the Applicant will be able to arrange for the facility for conducting the Tests within the factory
2. In case of application for extension of permission -
(a) Whether the applicant has maintained proper accounts of excisable goods sent for testing and tested excisable goods are received back
(b) If not, action taken thereon
(c) Whether any misuse is noticed on the part of the Applicant while operating under the Rule 16C permission already granted
3. Whether the applicant/processor(s) is/ are involved in Central Excise case at any time; if so state the nature of offence)
4. General Remarks

Signature of Range Superintendent

(PART III)

(To be completed at Divisional Level)

1. Whether the applicants request deserves consideration for grant of permission / extension of permission
2. General Remarks

Signature of Divisional DC / AC