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Bill of Export For Goods Under Claim For Duty Drawback

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..... le [ ] Consignment Export [ ] Others (Specify) [ ] Land Cus. Station Nature of Contract : CIF [ ] / CFR [ ] / FOB [ ] Other (Specify) [ ] Place of Delivery Country of Destination Exchange Rate U/S 14 of CA Currency of Invoice S. No. Marks Nos. No. Kind of Pkgs. Container Nos. 2 [Statistical Code, Description of Goods, and EXIM Scheme Code, where applicable] Quantity 2 [Value FOB PMV where applicable] Net Weight Gross Weight Total FOB Value in words Analysis of Export Value Currency Amount Full export value OR where not ascertainable, the value which exporter expects to receive on the sale of goods. FOB Value Freight .....

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..... rigin of goods] Export Trade Control If export under : Custom House Agent LIC No. Deferred Credit [ ] Joint Ventures [ ] Rupee Credit [ ] Others [ ] RBI s Approval/Cir. No. Date Lorry No./goods Train Wagon No. Originating From Type of Shipment : Outright Sale [ ] Consignment Export [ ] Others (Specify) [ ] Land Cus. Station Nature of Contract : CIF [ ] / CFR [ ] / FOB [ ] Other (Specify) [ ] Place of Delivery Country of Destination Exchange Rate U/S 14 of CA Currency of Invoice S. No. Marks Nos. No. Kind of Pkgs. Container Nos. 2 [Statistical Code, Description of Goods, and EXIM Scheme Code, where appl .....

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..... 6. Indent [ ] .. 7. Acceptance of Contract [ ] .. 8. Letter of Credit [ ] 2. Account No. . 3. DBK Ledger No. 9. QC Certificate [ ] 10. Any other (Specify) [ ] Item No. in B/E S. No. Sub S. No. of DBK Schedule Qty./Wt. On which DBK Claimed Value on which DBK claimed Rate of DBK Amount of DBK Excise Customs Excise Customs Total Total Amount in words : Rupees . Signature of Exporter/CHA 'LET EXPORT' Signature of Officer of Customs 'ALLOWED FOR SHIPMENT' .....

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..... very Country of Destination Exchange Rate U/S 14 of CA Currency of Invoice S. No. Marks Nos. No. Kind of Pkgs. Container Nos. 2 [Statistical Code, Description of Goods, and EXIM Scheme Code, where applicable] Quantity 2 [Value FOB PMV where applicable] Net Weight Gross Weight Total FOB Value in words Analysis of Export Value Currency Amount Full export value OR where not ascertainable, the value which exporter expects to receive on the sale of goods. FOB Value Freight Insurance Rate Commission Currency Discount Amount . Other Deductions S. No. .....

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..... STAMP Signature of Exporter/CHA 'LET EXPORT' Signature of Officer of Customs 'ALLOWED FOR DESPATCH Signature of Officer of Customs Claim Pre-audited for Sanction Claim passed for Rs. Inspector (Audit) Supdt./AC Claim Registration No. ..Issued Cheque No. Dated For Rs. .(Rupees ..) Dealing Clerk Officer Examination Order and Report 1 ANNEXURE V (See regulation 3) BILL OF EXPORT FOR GOODS UNDER CLAIM FOR DUTY DRAWBACK EXPORT PROMOTION COPY .....

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..... unt . Other Deductions S. No. Export Tariff No. Assessable Value under Sec. 14 of CA Duty Cess Total Duty Cess Duty payment particulars Rate Amount Rate Amount Total Duty/Cess Amount in words : Rupees Collection Stamp Declaration : I/We declare that all particulars given herein are true and correct. I/We also attach the declaration(s) under clause No.(s) .. Public Notice No................Dated................. Signature of Exporter/ CHA . Date Verified Railway Receipt No../Lorry Waybill No. ...................................................................Dated.............................. of ................................................................................................................................................................................... .....

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