Range Annexure-14
Division
Address
Commissionerate
Original (White)
Duplicate (Buff)
Triplicate (Pink)
Quadruplicate (Green)
FORM A.R.E. 1
Application for removal of excisable goods for export by (Air/Sea/Post/Land)*
To
Superintendent of Central Excise
(Full Postal Address)
1. Particulars of [Assistant/Deputy Commissioner of Central Excise]/Maritime Commissioner of Central Excise from
whom rebate shall be claimed/with whom bond/undertaking is executed and his complete postal address.
2. I/We of
.propose to export the under-mentioned consignment to (Country of destination)
by Air/Sea/Land/Parcel Post under claim for rebate/bond/undertaking *.
Particulars of Manufacturer No. and Gross Marks and
Quantity of Description of
of goods-and his Central Description of weight/ Nos.
goods Goods
Excise Registration No. packages Net weight on packages
(1) (2) (3) (4) (5) (6)
Duty No. and date of Invoice under which duty Amount of
Value was paid/No. and date of bond/undertaking Rebate Remarks
executed under Rule 19 claimed
Rate Amt. (Rs.)
(7) (8) (9) (10) (11) (12)
FormExcel 1 of 3
3. I/We hereby certify that the above- mentioned goods have been manufactured.
(a) availing facility/without availing facility of CENVAT credit under CENVAT Credit Rules, 2001
(b) availing facility/without availing facility under Notification 41/2001-Central Excise (N.T) dated 26th June, 2001
issued under rule 18 of Central Excise(No.2) Rules, 2001.
(c) availing facility/without availing facility under Notification 43/2001-Central Excise (N.T) dated 26th June, 2001
issued under rule 19 of Central Excise (No.2) Rules, 2001.
4. I/We hereby declare that the export is in discharge of the export obligation under a Quantity based Advance
Licence/Under Claim of Duty Drawback under Customs & Central Excise Duties Drawback Rules, 1995.
5. I/We hereby declare that the above particulars are true and correctly stated.
Time of Removal
Signature of owner or his
Authorised agent with date.
Name in Block Letters & Designation (SEAL)
PART A
Certification by Central Excise Office
1. Certified that duty has been paid by debit entry in the Personal Ledger Account No.
and/or CENVAT Account Entry No. or recorded as payable in Daily Stock Account,
the goods described overleaf.
2. Certified that I have opened and examined the packages No. and found that the
particulars stated and the description of goods given overleaf and the packing list (if any) are correct and that all the
packages have been stuffed in the container No. with Marks and the
same has been sealed with Central Excise Seal/One Time Seal (OTS) No.
3. I have verified with the records, the exporter is only availing the export incentives, as specified in box No.6. and
found it to be true.
4. Certified that I have drawn three representative samples from the consignment (wherever necessary) and have
handed over, two sets thereof duly sealed to the exporter/his authorised representative.
Place
Date
Signature Signature
(Name in Block Letters) (Name in Block Letters)
Superintendent of Central Excise Inspector of Central Excise
FormExcel 2 of 3
PART B
CERTIFICATION BY THE CUSTOMS OFFICER
Certified that the consignment was shipped under my supervision under Shipping Bill No dated
S.S./Flight No. which left on the day of (Month) (year)
OR
Certified that the above-mentioned consignment was stuffed in Container No. belonging to Shipping Line
based on the Let Export Order given on given on day of
(Month) (year) on the Shipping Bill No. dated and sealed by seal/one
time lock No. in my supervision and the container was handed over to the Custodian M/s
for being shipped via (Name of the Port).
OR
Certified that the above-mentioned consignment has been duly identified and has passed the land frontier today at
in its original condition under Bill of Exports No Place
date
Signature
(Name and designation of the Customs
Officer in Block Letters)/(Seal)
PART C
EXPORT BY POST
Certified that the consignment described overleaf has been despatched by foreign post to on
day of 200
REBATE SANCTION ORDER
(On Original, Duplicate and Triplicate)
Refund Order No. dated Rebate of Rs (Rupees
) sanctioned vide Cheque No.
dated
*Strike out inapplicable portions Assistant/Deputy Commissioner/ Maritime
Commissioner of Central Excise
NOTE:
FormExcel 3 of 3
