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Declaration Form
To
The Deputy Commissioner/Assistant Commissioner,
Central Excise,
I/We ……………………………………… declare that to the best of my/our knowledge and belief
the information furnished in the Schedule below is true and complete.
I/We ……………………………………….declare that wherever the exemption has been claimed
on the basis of conditions mentioned in the notification(s) or in Central Excise Tariff Act, 1985 (5
of 1986), the said conditions have been fulfilled by me/us.
I/We undertake to apply for Central Excise Registration in the proper form as soon as the value of
the goods, mentioned in the said Schedule, cleared for home consumption in a financial year,
reaches the full exemption limit or as soon as the goods mentioned in the Schedule become
chargeable to duty.
I/We undertake to maintain such records and follow such procedure as may be specified by the
Commissioner in relation to the exempted goods.
I/We also undertake to intimate any change in the information furnished in the said Schedule.
The Schedule
1. Name and full address of the factory.
2. Name and addresses of other factories/manufacturers (producing such goods) in whom the
manufacturer claiming the exemption has proprietary interest.
3. Status of business (tick only one box)
Proprietorship Partnership Registered Company
Unregistered Company Trust Society Others