[see rule 4(1) and (3)]

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..... at Concessional Rate of Duty for Manufacture of Excisable and Other Goods) Rules, 2016 To, The Assistant Commissioner or Deputy Commissioner of Central Excise, Division .......... , Sir, We intend to avail benefit of exemption of duty for the purpose of manufacture of goods in our factory. The details of the goods proposed to be procured, quantity, duty foregone, S.No of the notifi .....

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..... . We have executed the necessary letter of undertaking or bond with surety. Date : Place : Signature and stamp of authorised signatory, with name and address of the premise , (Registration Number) (Suitably amend for multiple supplier manufacturer) - - statute, statutory provisions legislation, law, enactmen .....

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