(Note:- see Central Excise (No.2) Rules, 2001)

“Annexure - I

Original
Duplicate

Form A-1
APPLICATION FOR CENTRAL EXCISE REGISTRATION
(see rule 9 of Central Excise Rules, 2002)

New Registration	c
Amendments to information pertaining to existing Registrant	c
Registration Number in case of existing Registrant	ccccccccccccccc

Part I: Identification of business requiring Registration (Manufacturing, Warehousing, hundred percent Export Oriented Undertaking, Unit in Export Processing Zone , First Stage Dealer, Second Stage Dealer )

1. Name of the Registrant (Please see instruction No. 5)
cccccccccccccccccccccccccccccccccccc
cccccccccccccccccccccccccccccccccccc
2. Details of Permanent Account Number (PAN) (Please see instruction No.6)

(i) Whether PAN has been issued by the Income Tax Department               Yes     c          No     c

(ii) If yes, the PAN                                                 cccccccccc

(iii) Name of the Registrant (as appearing in PAN)
cccccccccccccccccccccccccccccccccccc

(iv) If PAN is not available, whether applied for PAN                                 Yes     c          No     c

3. Category (tick only one box)
Manufacturer		c		Warehouse		c
Export Oriented Undertaking		c		Unit within Export Processing Zone		c
Manufacturer’s Depot		c		Dealer		c
4. Constitution of business (tick only one box) (Please see instruction No. 7)
Proprietorship	c	Partnership	c	Registered Company	c
Unregistered Company	c	Trust	c	Society	c	Others	c

5. Address of business premises

(i) Name of Premises/Building
cccccccccccccccccccccccccccccccccccc
(ii) Flat/Door/Block No.
cccccccccccccccccccccccccccccccccccc
(iii) Road/Street/Lane
cccccccccccccccccccccccccccccccccccc
(iv) Village/Area/Locality
cccccccccccccccccccccccccccccccccccc
(v) Block/Taluk/Sub-Division/ Town
cccccccccccccccccccccccccccccccccccc
(vi) Post office
cccccccccccccccccccccccccccccccccccc
(vii) City/District
cccccccccccccccccccccccccccccccccccc
(viii) State/Union Territory
cccccccccccccccccccccccccccccccccccc
(ix) PIN
cccccc
(x) Telephone Nos.: (Please see instruction No.8)
cccccccccccccccccccccccccccccccccccc
(xi) Fax No. (Please see instruction No. 8)
cccccccccccccccccccccccccccccccccccc
xii) E-mail Address
cccccccccccccccccccccccccccccccccccc

6. Define boundaries of the premises to be Registered (Please see instruction No.9)

(i) North
cccccccccccccccccccccccccccccccccccc
(ii) East
cccccccccccccccccccccccccccccccccccc
(iii) West
cccccccccccccccccccccccccccccccccccc
(iv) South
cccccccccccccccccccccccccccccccccccc

7. Details of property holding rights of the Registrant with respect to the premises sought to be Registered (tick only one box)

     Ownership     c          Lease/Rent     c

If owned whether mortgaged/ hypothecated:                              Yes    c           No    c

8. Estimated investment in land, plant and machinery (Rupees in Lakh):
cccccccc

9. Address of Head Office if different from that given at S.No. 5 above

(i) Name of Premises/Building
cccccccccccccccccccccccccccccccccccc
(ii) Flat/Door/Block No.
cccccccccccccccccccccccccccccccccccc
(iii) Road/Street/Lane
cccccccccccccccccccccccccccccccccccc
(iv) Village/Area/Locality
cccccccccccccccccccccccccccccccccccc
(v) Block/Taluk/Sub-Division/ Town
cccccccccccccccccccccccccccccccccccc
(vi) Post office
cccccccccccccccccccccccccccccccccccc
(vii) City/District
cccccccccccccccccccccccccccccccccccc
(viii) State/Union Territory
cccccccccccccccccccccccccccccccccccc
(ix) PIN
cccccc
(x) Telephone Nos.: (Please see instruction No.8)
cccccccccccccccccccccccccccccccccccc
(xi) Fax No. (Please see instruction No. 8)
cccccccccccccccccccccccccccccccccccc
(xii) E-mail Address
cccccccccccccccccccccccccccccccccccc

10. Name, designation and address of the person signing this Application Form and of the authorised person(s): (Please see instruction No.10)

(i) Name
cccccccccccccccccccccccccccccccccccc
(ii) Designation
cccccccccccccccccccccccccccccccccccc
(iii) Name of Residential Premises/Building
cccccccccccccccccccccccccccccccccccc
(iv) Flat/Door/Block No.
cccccccccccccccccccccccccccccccccccc
(v) Road/Street/Lane
cccccccccccccccccccccccccccccccccccc
(vi) Village/Area/Locality
cccccccccccccccccccccccccccccccccccc
(vii) Block/Taluka/Sub-Division/ Town
cccccccccccccccccccccccccccccccccccc
(viii) Post office
cccccccccccccccccccccccccccccccccccc
(ix) City/District
cccccccccccccccccccccccccccccccccccc
(x) State/Union Territory
cccccccccccccccccccccccccccccccccccc
(xi) PIN
cccccc
(xii) Telephone Nos.: (Please see instruction No. 8)
(a) Office
cccccccccccccccccccccccccccccccccccc
(b) Residence
cccccccccccccccccccccccccccccccccccc
(xiii) Fax No. (Please see instruction No. 8)
cccccccccccccccccccccccccccccccccccc
(xiv) E-mail Address
cccccccccccccccccccccccccccccccccccc

11. Details of Bank Accounts used for business transactions by the Registrant (Please see instruction No. 11)

(a) Number of Bank Accounts          c
(b) Account 1
(i) Name of the Bank
cccccccccccccccccccccccccccccccccccc
(ii) Name of the Branch
cccccccccccccccccccccccccccccccccccc
(iii) Account No.
cccccccccccccccccccccccccccccccccccc
(c) Account 2
(i) Name of the Bank
cccccccccccccccccccccccccccccccccccc
(ii) Name of the Branch
cccccccccccccccccccccccccccccccccccc
(iii) Account No.
cccccccccccccccccccccccccccccccccccc

Part II: Business Transaction Number obtained from other Government Agencies/Departments

12. Details of Business Transaction Numbers obtained from other Government Agencies/Departments (Please see instructions No. 12 and 13)

(i) Customs Registration No. (BIN No.)                                               Yes     c          No     c
    If yes, give details
ccccccccccgccgccc

(ii) Directorate General Foreign Trade’s Import Export Code No.               Yes     c          No     c
If yes, give details
ccccccccccgccgccc

(iii) Sales Tax Registration Nos.
(a) State Sales Tax No.                                                                   Yes     c          No     c
If yes, give details
ccccccccccccccccccccc

(b) Central Sales Tax No.                                                                 Yes     c          No     c
If yes, give details
ccccccccccccccccccccc

(iv) Registrar of Company’s CIN No.                                                    Yes     c          No     c
If yes, give details
ccccccccccccccccccccc

Part III: Proprietor/Partners/Chief Executive Officer /Chairman /Managing Director/Trustee etc.

13. Mode of business (Please see instruction No. 14)

(i) Name
cccccccccccccccccccccccccccccccccccc

(ii) Designation
cccccccccccccccccccc

(iii) Name of Residential Premises/Building
cccccccccccccccccccccccccccccccccccc

(iv) Flat/Door/Block No.
cccccccccccccccccccccccccccccccccccc

(v) Road/Street/Lane
cccccccccccccccccccccccccccccccccccc

(vi) Village/Area/Locality
cccccccccccccccccccccccccccccccccccc

(vii) Block/Taluk/Sub-Division/ Town
cccccccccccccccccccccccccccccccccccc

(viii) Post office
cccccccccccccccccccccccccccccccccccc

(ix) City/District
cccccccccccccccccccccccccccccccccccc

(x) State/Union Territory
cccccccccccccccccccccccccccccccccccc

(xi) PIN
cccccc

(xii) Telephone Nos.: (Please see instruction No. 8)
cccccccccccccccccccccccccccccccccccc

(a) Office
cccccccccccccccccccccccccccccccccccc

(b) Residence
cccccccccccccccccccccccccccccccccccc

(xiii) Fax No. (Please see instruction No. 8)
cccccccccccccccccccccccccccccccccccc

(xiv) E-mail Address
cccccccccccccccccccccccccccccccccccc

(xv) PAN (issued by the Income Tax Department)
cccccccccc

PART IV: Major Excisable goods to be manufactured, warehoused or traded/ Major inputs

14 Major excisable goods manufactured, warehoused or traded (description and CETSH)
(Please see instruction No. 15)

(i)______________________ (ii) ____________________ (iii) ____________________

15. Major excisable goods used in the manufacture of final product (description and CETSH)
(Please see instruction No. 15)

(i)______________________ (ii) ____________________ (iii) ____________________

DECLARATION

I, ________________________________________________ hereby declare that the information given in this Application Form is true, correct and complete in every respect and that I am authorised to sign on behalf of the Registrant.

(Please tick appropriate box)

(a) For new Registration/Amendment to Registration Certificate      c

I would like to receive the Registration Certificate –

by mail at the address specified at S. No. ______ of Part-I                       c

by Hand         c

(b) For amendments to information pertaining to existing Registrant

The above mentioned amendments are with effect from cc/cc/cccc

(Signature of the applicant/authorised person with stamp)
(Please see instruction No. 16)

Date:
Place:

ACKNOWLEGEMENT
(To be given in the event Registration Certificate is not issued at the time of receipt of Application for Registration)
I hereby acknowledge the receipt of your Application Form

(a) For new Registration / amendments to existing Registration Certificate           c

As desired, the New Registration Certificate will be sent by mail/ handed over to you in person on
cc/cc/cccc

(b) For amendments to information pertaining to existing Registrant                    c

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

Date:

Instructions for filling up the Application Form for Registration

1) This Application Form should be used for applying for Registration as also for informing any corrections/ changes in the information, subsequent to Registration. Any change in the information subsequent to Registration, except those under Part IV, must be brought to the notice of the Central Excise Department. Such changes should be indicated by ticking the relevant box at the top of the Form, providing the Registration Number and filling up only such information that has undergone change leaving the boxes for information not to be amended blank.

2) The Application Form has to be filled in Duplicate, and submitted to the Deputy Commissioner of Central Excise or Assistant Commissioner of Central Excise, having jurisdiction over the place of business.

3) Export Oriented Units and Units in Export Processing Zones in the Port Towns/cities which are in the jurisdiction of Commissioners of Customs would submit the Application Form to the concerned Deputy Commissioner of Customs or Assistant Commissioner of Customs.

4) After entering the relevant details, extra boxes in a field may be left blank. Also one box may be left empty after completion of each entry. For example more than one telephone number may be given as under:

0

1

1

3

0

9

2

8

2

9

0

1

1

3

0

9

2

8

3

0

5) The name should be the name and style in which the Registrant is likely to carry out business from the premises seeking to be registered. Please do not mention any prefixes such as M/s, Mr., Sh., etc

6) An attested copy of PAN allotted by the Income Tax Department should be enclosed; in case PAN has not been allotted attested copy of the acknowledged application for PAN should be enclosed.

7) A registered company means, a company registered with the Registrar of Companies under the Companies Act, 1956 (1 of 1956) and having a CIN number. Unregistered means a company that is not so registered

8) Telephone and fax numbers to be given with NSD code, without leaving a gap.

9) The description of the boundaries of the premises to be registered, should correspond to the one given in the Land Records.

10) If there are more than one authorized persons, information is to be provided in respect of all in a separate sheet in the same box format.

11) In case the Registrant has more than one Bank Account, for transacting his business, only two accounts with the maximum transactions must be mentioned.

12) The details relevant to the Registrant only are to be filled. The details of businesses carried out from other premises need not be filled.

13) If the status of the company is shown as Registered Company in Part I 4, then the information in Part II 12 (iv) is mandatory.

14) The maximum number of persons, whose details are to be provided, should not exceed seven. In the case of a partnership firm, details of partners are to be provided; in case of Registered /unregistered company, the details of its Chief Executive Officer /Chairman and Managing Director/Managing Director/Chairman/ key Directors as per relevance are to be provided; in the case of Society, the details of its President, key Executive Members, are to be provided; in case of any other type of business, the details of key personnel engaged in management of the business are to be provided. If more names are to be provided the information shall be provided in respect of all in a separate sheet in the same manner.

15) The details of the three major excisable goods/inputs likely to be manufactured/used/traded should be mentioned.

16) The instructions in respect of the person signing the Application for registration are as under:

(a) The Application may be signed by the Registrant himself or by his authorised agent having general power of attorney.

(b) The person signing the Application must be a holder of Permanent Account Number (PAN) allotted by the Income Tax Department.

(c) In case of unregistered partnerships, all the partners should sign the application.

(d) In case of registered Partnership the Managing Partner or other partners so authorised in the Partnership Deed may sign the application.”;

(Annexure-I has been substituted vide Ntf. No. 30/2002-CE, Dt. 17/09/2002)

[OLD -
(Note:- This (Annexure-I) has been substituted by Ntf. No.65/2001-CE(N.T.), dt.17/10/2001)

ANNEXURE-1

FORM A-1

Application for Registration to cure/produce/manufacture/conduct wholesale trade/act
as a broker or commission agent/obtain excisable goods, for industrial purpose etc.
[ Rule 9 ]
(Delete the letters and words not applicable)

To

The Superintendent of Central Excise,

Sir,

I/We_____________________________Son/Daughter(s) of_______________________________ residing at____________________hereby request that I/We _______________________ may be issued a registrationcertificate under Rule 9 for the purposes indicated in the schedule. Other details required are also furnished in the schedule.

2. I/We___________________ agree to abide by all the terms and conditions of the registration which may be imposed from time to time.

3. I/We_________________________ agree to abide by all the provisions of Central Excise (No.2) Rules, 2001 and any orders issued thereunder.

4. I/We_________________ declare to the best of my/our knowledge and belief the information furnished herein is true and complete.

Place: Date:

Signature of the applicant (Signatures)

................................tear here................................

ACKNOWLEDGEMENTReceived an application for Registration from Ms./Mr./Smt. __________________ Son/Daughter of __________________ for registration under Rule 9

Date:

Rubber stamp of the officer receiving the application.

SCHEDULE

1. Name and address of the person
applying for the registration :

2. Details of the premises where the activity proposed is to be carried on :
(attach details of plan of Building/Plant/Machinery etc.)

3. Details of the proprietors/all partners/Directors of the company including :

(a) Name(s)

(b) Address(es)

(i) Official

(ii) Residential

(c) Income Tax No./Nos.

4.

Sl.No.

Description of Excisable goods

Tariff Classification

The purpose for which the registration is sought for

Remarks


5. In case the application is for obtaining excisable goods to be used for special industrial purposes, additional details as below may be furnished.

(i) Estimated quantity of each case :
of goods and value of such goods
likely to be used during the year

(ii) Commodities to be manu- :
factured and issue of each
commodity during the year

(iii) Manner of manufacture :

(iv) Purpose to which :
manufactured product
is supplied

(v) Source from which excisable :
goods will be obtained

(vi) Remarks :

6. In case the application is for obtaining permission for warehousing, additional details in the format furnished below may be given:

1. Village/town

2. District



---

Distinguishing letter or number or Detailed description of each Purpose of each
letter and number of each

---


3. Description of each main :
division or sub-division of the
warehouse or store-room

4. Area and total storage capacity :
5. Varieties of excisable product to :
be stored

6. Estimated quantity of each :
variety of such products to be
stored during each financial year: ]

(Back to Part-I of Ch.2)

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