25th November. 2004

Notification No. 40/2004-Central Excise (N.T.)

Customs hereby specifies the following Form for the purposes of the said rule, namely, –


{sub-rule (1) of rule 9A of CENVAT Credit Rules, 2004}

1. Name of the manufacturer:

2.         PAN based Registration Number:                              

3. Annual Declaration

(i) New declaration

(ii) Amendments to declaration already filed

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(Pl. tick the appropriate box)

4. Declaration for the Financial Year ___________

Sr. No. Description of principal inputs Central Excise Tariff Sub-HeadingNo. of principal inputs Quantity code* Description of finished goods in which principal input mentioned in column (2) is used Central Excise Tariff Sub-Heading No. of finished goods Quantity code* Quantity of principal input mentioned in column (2) required for use in the manufacture of unit quantity of finished goods mentioned in column (5)
1 2 3 4 5 6 7 8

*NOTE.-Please indicate the abbreviation referred to in Instruction No. 7 mentioned in Form E.R.-1 and Form E.R.-3 specified in the Government of India, Ministry of Finance (Department of Revenue) vide No.25/2004-Central Excise (N.T.), dated the 27th September, 2004 published vide G.S.R.No.643 (E) dated the 25th September, 2004.

5. (i)  I/We _________________hereby declare that the information given above is true, correct and complete in every respect to the best of my/our knowledge and belief.

(ii) I/We am/are authorized to sign this declaration.

(Name in capital letters and signature
of the assessee or authorized signatory)




Declaration for the Financial Year ___________

                           D   D      M  M     Y  Y   Y  Y

Date of receipt                    



Name and signature of the officer with seal

F.No. 224/52/2004-CX 6

Neerav Kumar Mallick

Under Secretary to the Government of India

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Category : Excise Duty (4049)

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