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APPLICATION FOR CLAIM OF TED REFUND / DUTY DRAWBACK / BRAND RATE FIXATION

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..... ls: i. Address of the jurisdictional Customs Authority ii. Contact details of Jurisdictional Customs Authority iii. Amount duty paid during last year iv. Product registered for manufacturing activities 5. Application for: i. Refund of Terminal Excise duty ii. Refund of Duty Drawback as per AIR iii. Fixation of brand rate for duty draw back 6. Application is made by: (i) Supplier of goods (ii) Recipient of goods 7. Supply details: i. Description of goods ii. Category of supplies under Para 7.02 of FTP 8. If application is for refund on TED Sl. No. Inv. No. Date of Description of item(s) of supply Quantity Quantum of TED Late cut, if any Net claim Supply Payment .....

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..... 17. If claim for duty drawback is made by recipient of goods: Whether CENVAT credit has been availed by supplier of goods on excisable inputs? 18. In case of claim made against supply under Para-7.02(a) (c) whether authorization number and date figure in the supply invoices/ARE. 19. If the application is for fixation of brand rate: Drawback rate under AIR not available AIR is less than 4/5 of actual duty paid. (i) Claim is made for basic customs duty. 20. If answer to Col. 19 is yes, Whether: 1. Inputs/components were imported directly : 2. Imported inputs/component used from stock/ out sourced locally: DBK-I Statement Sl. No. Name of the materials/ Components Quali .....

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..... 11 12 13 14 15 16 ** Only inputs which were imported/ procured and consumed during the period commencing 90 days prior to the date of supply(s) shall only be taken into account for such claim. A separate work sheet as per DBK form II, and II(A) and certificates attached thereto duly certified by Chief Executive/production in-charge shall be submitted, as given in the APPENDIX-7E 23. Check List of documents to be attached duly scanned or submitted in the physical form at counter: (1) (a) Copy of Invoices or a statement of invoices duly signed by the units receiving the excisable goods and attested by Central Excise Authorities, as per the procedure prescribed by CBEC in their circular 15/2008-Cus. dated 26.9.2008. To facilitate attestation by Central Excise Authorities, intimation regarding receipt of goods should be given to the said authorities within 48 hours of receipt of goods. Corresponding ER-1/ER-3 or a monthly statement confirming duty paym .....

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..... concealed or held there from. If found incorrect or false, it will render me / us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted. 2. I/We undertake to abide by the provisions of F.T. (D R) Act, the Rules and Orders framed there under, the FTP, HBP, SION and the ITC(HS) Classification of Export Import Items. 3. I/we further declare that the claim made by me/us is not a matter of right and I/we shall immediately refund the amount of TED/drawback obtained by us in excess of any amount/rate which may be re-determined by concerned RA/DGFT/Government as a result of post verification/ Audit objection or otherwise. 4. None of the Proprietor/Partners(s)/Director(s)/Karta/Trustee of the firm/company has come under the adverse notice of DGFT or is in the caution list of RBI. 5. None of the Proprietor/Partners(s)/Director(s)/Karta/Trustee of the firm/company, as the case may be, is/are a Proprietor/Partner(s)/Director(s)/Karta/Trustee in any other firm/Company which has come under the adverse notice of DGFT or is in the caution list of RBI, to the best of my knowledge. 6. I / We hereby declare that no export proceeds are ou .....

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..... zation in respect of the aforesaid supply of goods and have not availed any benefit thereon. 4. The complete address of the Jurisdictional Assistant/Deputy Commissioner of the Central Excise Division is given as follows: Yours faithfully, Signature (Authorized Signatory) Full Name Designation Name of the Company Telephone Number Address Fax No. E-mail address Note : Declaration is to be given on letter head of the supplier. The Declaration furnished by the supplier to Office of the Development Commissioner or RA of DGFT should be in duplicate with complete address of the Jurisdictional Assistant/Deputy Commissioner of the Central Excise Division. The Development Commissioner/RA of DGFT would forward the second copy of this Declaration, duly stamped, to the addressed Assistant /Deputy Commissioner of the Central Excise Division for cross verification. ANNEXURE-III DISCLAIMER CERTIFICATE FOR NOT CLAIMING DEEMED EXPORT BENEFITS We hereby declare that we have neither drawn nor will draw any benefit of deemed export on supply of goods as declared/to be declared in the application for claim of deemed export benefits and we have no obje .....

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..... is applicable) (Application shall be filed online once the software is ready) 1. IEC No Branch Code: 2. Applicant details: (i) Name of the firm/company (ii) Full address (iii) Contact Number (iv) E-mail address 3. Bank s details: (i) Name of the Bank (ii) Address of the Bank (iii) IFSC code (iv) Nature of account(SA/CA) (v) A/c Number (vi) Telephone / Fax No. 4. Excise Authority details: (i) Excise Registration No (ii) Address of the jurisdictional Central Excise Authority (iii) Contact details of Excise Authority .....

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..... (Provision to add multiple supply Invoices) 10. If supply towards discharge of export obligation to Advance Authorisation Holder against Invalidation letter and drawback is claimed on inputs either imported or procured locally on payment of duty: Whether, in the application for Advance Authorisation for intermediate supply, it was declared that such inputs to be procured locally /imported on payment of duty? Yes/No 11. 1 [ If answer to Col. No. 10 is yes, Advance Authorization no. date and File. no. under which it was issued. ] 12. Whether claim is made within the prescribed time 13. If not, rate of late cut as per Para 9.02 of HBP 14. If claim for refund of TED is made by supplier: Whet .....

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..... Components Quality/ Technical Charachteristics Whether imported/ indigenous Unit Gross Quantity required Wastage Quantity Sale Price of waste per unit of Qty By Product/ co-product Net wt. of the material Remarks Irrecoverable Recoverable Qty. Sale value per unit 1 2 3 4 5 6 7 8 9 10 11 12 13 22. Statement of inputs/components used, either imported or procured locally ** S.No Description .....

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..... t through e-BRC as per APPENDIX-2U or Payment Certificate issued by Project Authority in APPENDIX-7D in original, as the case may be. (5) PAC issued by the Project Authority in original as per APPENDIX-7C or File No. where the original has been submitted. (6) 2 [ Copy of contract if supplies were made to Project Authority or supplier's copy of original ARO or recipient's copy of original Invalidation Letter, (If supply against ARO/Invalidation Letter issued against AA/DFIA/EPCH, as the case may be). ] (7) Non-availment of CENVAT credit certificate as per ANNEXURE-I, by the recipient of finished goods (in case claim for TED). (8) A certificate regarding non-availment of CENVAT credit on inputs used in the resultant product by the supplier of goods as per ANNEXURE-II (in case claim for drawback). (9) Declaration/disclaimer certificate from supplier, in case claim is filed by recipient of goods and from recipient of goods, if claim is filed by supplier of goods, as per ANNEXURE-III. (10) Statement of supplies for Fixation of Drawback Rate as per APPENDIX-7E. DECLARATION / UNDERTAKING 1. I/We hereby declare that the particulars and the statement .....

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..... se items as per the application. Signature (Authorized Signatory): Full Name: Designation: Name of the company: Telephone Number: E-mail Address: Fax No: Note: To be given on the letter head of the recipient of goods. ANNEXURE-II DECLARATION FOR CLAIMING DEEMED EXPORT DRAWBACK 1. I, (Name Designation) ..on behalf of M/s. .. (Name and address of the supplier) hereby certify that we have supplied the following goods to M/s .. (Name and address of the recipient): S. No. Inv. No. date Description of goods Unit Qty. Value 2. We are the manufacturer exporters/suppliers and are registered/not registered with Central Excise Authority and have not availed and will not avail CENVAT credit facility in respect of duty paid on inputs/components and/or tax paid on input services, in aforesaid supplies. We have also not availed and will not avail rebate on the duty paid on inputs/components used in aforesaid supplies and/or tax paid on input services. 3. We also certify that we have not been issued any Advance Authorization/Duty Free Impor .....

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..... imer Certificate: We hereby certify that we are not claiming any deemed export benefits on the above supplies and we do not have any objection if _______(Name of EOU/Project) claims deemed export benefits. Authorized Signatory (With full name and Designation) 4. Substituted vide PUBLIC NOTICE No. 18/2015-2020 dated 23-09-2020 before it was read as 3 [ANF-7A APPLICATION FOR CLAIM OF TED REFUND / DUTY DRAWBACK / BRAND RATE FIXATION (Please tick whichever is applicable) (Application shall be filed online once the software is ready) 1. IEC No Branch Code: 2. Applicant details: (i) Name of the firm/company (ii) Full address (iii) Contact Number (iv) E-mail address 3. Bank s details: (i) Name of the Bank .....

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..... (ii) Recipient of goods 7. Supply details: (i) Description of goods (ii) Category of supplies under Para 7.02 of FTP 8. If application is for refund on TED Sl. No. Inv. No. Date of Description of item(s) of supply Quantity Quantum of TED Late cut, if any Net claim Supply Payment (Provision to be made to add multiple invoices) 9. Deleted 10. If supply towards discharge of export obligation to Advance Authorisation Holder against Invalidation le .....

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..... 20. If answer to Col. 19 is yes, Whether: 1. Inputs/components were imported directly : 2. Imported inputs/component used from stock/ out sourced locally: 21. DBK-I Statement SL No Name of the materials/ Components Quality/ Technical Characteristics Whether imported/ indigenous Unit Gross Quantity required Wastage Quantity Irrecoverable Recoverable 1 2 3 4 5 6 7 8 .....

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..... IX-7E 23. Check List of documents to be attached duly scanned or submitted in the physical form at counter: (1) (a)Copy of Invoices or a statement of invoices duly signed by the units receiving the excisable goods and attested by Central Excise Authorities, as per the procedure prescribed by CBEC in their circular 15/2008-Cus. dated 26.9.2008. To facilitate attestation by Central Excise Authorities, intimation regarding receipt of goods should be given to the said authorities within 48 hours of receipt of goods. Corresponding ER-1/ER-3 or a monthly statement confirming duty payment attested by excise Authorities or Invoices/statement of Invoices certified by Jurisdictional Central Excise Authority of recipient. (b) In case of supply of non-excisable goods, copy of Tax invoices as prescribed under GST Rules or a statement of invoices duly signed by the units receiving the goods and attested by Jurisdictional Customs Authorities, as per the procedure prescribed by CBEC in their circular 15/2008-Cus. dated 26.9.2008. To facilitate attestation by Jurisdictional Customs Authorities, intimation regarding receipt of goods should be given to the said authorities within 48 .....

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..... mpany has come under the adverse notice of DGFT or is in the caution list of RBI. 5. None of the Proprietor/Partners(s)/Director(s)/Karta/Trustee of the firm/company, as the case may be, is/are a Proprietor/Partner(s)/Director(s)/Karta/Trustee in any other firm/Company which has come under the adverse notice of DGFT or is in the caution list of RBI, to the bestof my knowledge. 6. I / We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which AD/RBI permission has been obtained. 7. I/we further declare that the goods supplied are excisable goods but no CENVAT credit is availed/ available to the recipient of goods. (In case of items covered under schedule 4 of the central excise Act 1944). 8. I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 9.06 of the FTP. Signature of the Applicant Name Designation Official Address Telephone/Mobile No Residential Address Email Address Place Date ANNEXURE-I DECLARATION FOR CLAIMING BENEFIT OF TERMINAL EXCISE DUTY (TED) It is certified that no CENVAT credit unde .....

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