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APPLICATION FOR CENTRAL EXCISE REGISTRATION [see rule 9 of Central Excise Rules, 2002]

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..... Part I: Identification of business requiring Registration (Manufacturing, Warehousing, hundred percent Export Oriented Undertaking, Unit in Export Processing Zone , 1 [Importer], First Stage Dealer, Second Stage Dealer ) 1 Name of the Registrant (Please see instruction No. 5) 2. Details of Permanent Account Number (PAN) (Please see instruction No.6) (i) Whether PAN has been issued by the Income Tax Department Yes No (ii) If Yes, the PAN .....

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..... 5. Address of business premises (i) Name of Premises/Building (ii) Flat/Door/Block No. (iii) Road/Street/Lane (iv) Village/Area/Locality (v) Block/Taluk/Sub-Division/ Town .....

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..... 7. Details of property holding rights of the Registrant with respect to the premises sought to be Registered (tick only one box) Ownership Lease/Rent If owned whether mortgaged/ hypothecated Yes No 8. Estimated investment in land, plant and machinery (Rupees in Lakh): 9. Address of Head Office if different from that given at S.No. 5 above .....

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..... 10 Name, designation and address of the person signing this Application Form and of the authorised person(s): (Please see instruction No.10) (i) Name (ii) Designation (iii) Name of Residential Premises/Building (iv) Flat/Door/Block No. (v) Road/Street/Lane .....

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..... 11 Details of Bank Accounts used for business transactions by the Registrant (Please see instruction No. 11) (a) Number of Bank Accounts (b) Account 1 (i) Name of the Bank (ii) Name of the Branch (iii) Account No. (c) Account 2 .....

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..... (iii) Sales Tax Registration Nos. Yes No (a) State Sales Tax No. Yes No If yes, give details (b) Central Sales Tax No. Yes No If yes, give details .....

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..... (viii) Post office (ix) City/District (x) State/Union Territory (xi) PIN (xii) Telephone Nos.: (Please see instruction No. 8) (a) Office .....

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..... DECLARATION I, hereby declare that the information given in this Application Form is true, correct and complete in every respect and that I am authorised to sign on behalf of the Registrant. (Please tick appropriate box) (a) For new Registration/Amendment to Registration Certificate I would like to receive the Registration Certificate by mail at the address specified at S. No. ______ of Part-I .....

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..... I hereby acknowledge the receipt of your Application Form (a) For new Registration / amendments to existing Registration Certificate As desired, the New Registration Certificate will be sent by .....

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..... relevant box at the top of the Form, providing the Registration Number and filling up only such information that has undergone change leaving the boxes for information not to be amended blank. 2) The Application Form has to be filled in Duplicate, and submitted to the Deputy Commissioner of Central Excise or Assistant Commissioner of Central Excise, having jurisdiction over the place of business. 3) Export Oriented Units and Units in Export Processing Zones in the Port Towns/cities which are in the jurisdiction of Commissioners of Customs would submit the Application Form to the concerned Deputy Commissioner of Customs or Assistant Commissioner of Customs. 4) After entering the relevant details, extra boxes in a field may be left blank. Also one box may be left empty after completion of each entry. For example more than one telephone number may be given as under: 0 1 1 3 0 9 2 8 2 9 0 1 1 3 0 9 2 8 3 0 5) The name should be the name and style in which the Registrant is likely to carry out business fro .....

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