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

ANNEXURE-30

Original
Duplicate
Triplicate
Quadruplicate

Application for removal of stainless steel patties/pattas manufactured under the special procedure

Name of the Factory....................
Address................................


1. I/We................................................manufacturer(s) of stainless steelpatties/pattas residingat................Taluka/Tehsil................District.................... andholder(s) of Central Excise Registration No. .................dated.................having been permitted toavail myself/ourselves of the special procedure contained in the notification issued under rule15 of Central Excise (No.2) Rules 2001, in respect of my/our production and transactions insuch stainless steel patties/pattas at the above-mentioned factory/factories hereby declarethat I /we intend to install and employ the cold rolling machines for the production of stainlesssteel patties/pattas during the year................in the manner indicated below, and the total sumpayable by me/us in terms of the provisions laid down in the notification in respect of the saidperiod are stated hereunder:-

No. of cold rolling Machines to be installed and employed	Rate prescribed in Government of India Notification No. /2001- Central Excise dated	Sum payable	Total
(1)	(2)	(3)	(4)

2. I/We tender herewith the sum of Rs...............(Rupees...............only). The balance will bepaid by me/us in monthly installments.

3. I/We hereby declare that the particulars furnished herein are true and complete to thebest of my/our knowledge and belief.

4. I/We apply for leave to remove from the above mentioned premises during the periodfrom ..............to..............any stainless steel patties/pattas manufactured in the said premisesduring that period.

5. I/We understand that the permission accorded to me/us for the year............is subject tomy/our paying the balance amount as indicated in paragraph 2 above.

Place......................

Date........................

Signature of manufacturer or his authorized agent.

To

The Superintendent of Central Excise
.................Range
.................Division

COUNTERSIGNEDPlace......................

Date......................

Superintendent of Central Excise
.................Range
.................Circle.

Statement of duty paid:
(a) For payment in cash at....................

Treasury
State Bank of India
Reserve Bank of India

(To be filled in by the manufacturer or his authorised agent)

Name of person tendering payment	Particulars of payment	Amount(in words as well as in figures)
(1)	(2)	(3)

Head of Account
038-Union Excise Duties- Stainless steel patties/pattas
(b) Under the compounded levy scheme.

Date................

Signature of the tenderer

(To be filled in by the Treasury or Bank)

CERTIFICATE
Deposit Number....................Date.................Received payment of rupees (in words)..................

Signature of Treasurer or
Accountant Agent or Manager

(c) For payment through account-current:

Title of Account of Ledger	Number and date of entry	Amount (in words as well as in figures)
(1)	(2)	(3)

Place....................

Date.....................

Signature of the manufacturer or his Authorized agent.

(d) For payment through T.R.5/Special Revenue Money Order

Date of Payment	T.R.5 No./Special Money Order Coupon No.	Amount(in words as well as infigures)
(1)	(2)	(3)

Place....................

Date.....................

Clearance allowed subject to fulfillment of the condition of deposits

Superintendent of Central Excise

Note: Delete the entries not applicable.

(Back to Part-II of Ch.12)

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