41

Range : HO.208,2NO Fl.'0' TYPE NOR11I DNo4AN Division: BlOO.SOMNATM Commissionerate:OJMI\II To. Superintend"'!tof Central Excise, Range : ri NOR11IIWioWC , ROaNNO.208,2ND TYPE R..'O' ~TM
1..Partlculars.of Asstll Dt!paty Commissioner of Cen~
Excise

A.R.E.-1
Application for Removal of Excisable Goods For EXPORT by [Air .'6"131Peat I Land) [ Rule 18 I Ru!e 19 of the Central Excise Rules. 2002 )
OUR A.R.I. f 110. fIIL.Df.IU

A.R.E.-1No.~'7 0rignaI . WMe

D<4>I<aIo Ir1>Icate

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complete postaladdress is ON-NOfffif nd eI" u . err, gn"

bill 'b dl d k.

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1Mb,il;",g eV,,,,,,b6iu,,;', vr C""I,~1 EAei- "'m' WlIUfIl..,bc.~ snail oe Clalmemwith whom lilinlt-I undertaking Is executed and his '1:.

2N9f&:8' TYPEII.DG.IDIM~

propose exporttheLId. undermentionedconsiQnmentto 2.UW.toNh 0- UNI81 " ",18t

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un erta tng
No. and
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Remarks

0.-

(Countryof Destination)!by~ 7- ~:J()())' I

I I Duty Value Ra, Rate %

LandI P~

, '
Amount
R.. No. and Date of Invoice under which

Particuiars f manufacturer o

'>

goods and his Central Ex.

I'!egn, No.

Descnptionpf Packages

. Marks and Gross Weight I.. Net Weight Nos, on Packages

Quantity of Goods

, Desaiption

dutywas paid1No.

of Goods

"
6 =

and data of bond I undertaking executed under Rule 19

Amountof Rebateclaimed Rs.

<} 1-

10

11

12

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lIWe hereby certify thai the Aveiling facilrty I_.

abov_tioned

Ii.

goods have been manufeetured, I TO,of c..nvet credO unde< Cenvat COIdO

Ru"",, Excise

2004, (N,T,) dated (N,T,), the

(bJ

A.oi!;.,. "'..Hlli f without evamng facility unde< ";'fification 2112OO4-Cenfrol 6th September, 2004 issued under Rule 180fCentrai Exci.e Rules, 2002.

.&. d9V'061.2011 9MEOFREMOVAL 11..LfO (E-/t-.tWv! ,LO'}t .,<'t') )

Hrs.

For

Pidilite In UStri Ltd.

Ic)

4. 5.

A..ili .. ".11'1, f without the 26th June, 2001 issued

avem". facility under under Rule 19 of Central i.

Notification 4312001-Centrel Exci.e Rule., 2002.

Excise

dated'

export obligetion under a auanti!J[olfooadAdvence lioen~UnderCtaimofDutyOnl. . underCuOIOmsand Central Exci.e Duties OroWl>?"RuteS, 1995. lIWe herebydedarethe'the"""""particularsare trueand correctly stated,

I/We her"""'dare

that the export

in disohe rgehe

Signature 01owner Ofhis euthorised agent with date. Name in 8Iock letten; & Designalion (SEAl)

rIh AU[,t~

"'h'lh"J,<tJ Yf/P !lnatory ""- )

UtI

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