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					Quarterly return for production and removal of goods under exemption notification


                                           “Form-A
                                         (See rule 12)


1. Name and address of the assessee / manufacturer :

2. PAN :

3. Range ________Division________________Commissionerate________________

4. Period of return: Quarter ending _______________________

5. Details of the manufacture and removal of goods under  Notification No. 49/2003-
CE dated the 10th June, 2003 or  Notification No. 50/2003-CE dated the 10th June,
2003 (Tick whichever is applicable):


                                              Table


8-       Descriptio   Unit of   Quantity      Quantity and value of goods removed from factory
Digit    n of goods   quantit   manufacture   Export              Sale within       Other removals
Centra                y         d                                 India             not involving
l                                                                                   sale such as
Excise                                                                              transfer of
Tariff                                                                              goods to a depot
Item                                                                                or transfer to
No.                                                                                 another factory,
                                                                                    etc.
                                              Quantit    Valu     Quantit     Valu  Quantit      Valu
                                              y          e        y           e     y            e
                                                         (Rs)                 (Rs)               (Rs)
(1)      (2)          (3)       (4)           (5)        (6)      (7)         (8)   (9)          (10)




6. Please indicate if any raw material or inputs have been procured from or any
clearances mentioned in from Column (7) to (10) have been made to any related person
or another unit of the same manufacturer. If so, please furnish the following information :


(a) Name and address of the related person/unit :

(b) PAN number of the related person/unit :
(c) Quantity of raw material/input received_____ and value thereof _______

(d) Quantity of goods cleared________ and value thereof __________

I hereby declare that the information given above is true, correct and complete in every
respect.

(Signature and name of the manufacturer or authorized signatory)

Place:_________

Date:__________


                                   ACKNOWLEDGMENT


                                                                    Q       Q       Y   Y   Y       Y
Return of goods produced and manufactured by availing exemption
notification No.49/2003-CE / No.50/2003-CE for the quarter ending



                           D       D             M       M              Y       Y       Y       Y
Date of receipt



: (Name and signature of the competent Officer with official seal)

				
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