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Application for claiming refund of service tax paid on specified services used for authorised operations in SEZ under notification No.12/2013- Service Tax dated 1st July, 2013

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..... (iii) Address of the registered/Head Office with telephone and email: (iv) Permanent Account Number (PAN) of the SEZ Unit/Developer: (v) Import and Export Code Number: (vi) Jurisdictional Central Excise/Service Tax Division: (vii) Service Tax Registration Number/Service Tax Code / Central Excise registration number: (viii) Information regarding Bank Account (Bank, address of branch, account number) in which refund amount should be credited/to be deposited: (ix) Details regarding service tax refund claimed: claim refund of Rs.................. (Rupees in words) as per the details furnished in the Table I and Table II below for the period from____________ to______________. (A) Refund of service tax in respect of .....

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..... STC No. of service provider Invoice* No. Date Value of service Service tax + cess Amt Amount distributed to the SEZ Unit/Devel-oper out of the amount mentioned at column No. (8) Document* under which amount mentioned at column (9) was distributed to the SEZ Unit/Developer (Claimed as refund) No. Date ( 1) (2) (3) (4) .....

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..... earlier, on the basis of above documents/information; (v) we have not taken any CENVAT credit under the CENVAT Credit Rules, 2004 of the amount being claimed as refund; (vi) proper account of receipt and use of the specified services on which exemption/refund is claimed, for the authorised operations in the SEZ, is maintained and the same shall be produced to the officer sanctioning refund, on demand. Signature and name (of proprietor/managing partner/ person authorised by managing director of the SEZ Unit/Developer) with complete address, telephone and e-mail. Date: Place: - Forms .....

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