STATEMENT-DBK-III

Materials/Components of Indian origin obtained by the Manufacturer during the period commencing three months prior to the date of shipment/first shipment upto the date of application for manufacture of __________________________________________________(Name of export product).

S.No.	Description	S.No.in DBK I Statement	Unit	Qty. purchased	Assessable value
1	2	3	4	5	6

Effective Rate of duty paid	Amount of duty paid	Name & Address of supplier	Invoice No. & date	Is assessment of duty final	Remarks
7	8	9	10	11	12

Note:-

1. In this statement details of only those items which are chargeable to the excise duty to be given for which proof of C.Excise duty can be established by the relevant invoices/documents relating to payment of Central Excise duty.

2. If the assessment which is not final or duty is paid under protest the extent of dispute may please be clearly indicated.

3. Refund applications made, if any, against any duty paying document/Invoice, details thereof may please be furnished.

4. Stock position of the above materials/components also to be given separately (in linked statement III-A).

5. The Invoices ( in original) evidencing payment of Central Excise Duty are required to be attached. In case the quantity procured under payment of Central Excise Duty gets exhausted with this Brand Rate application, the same will be retained in the Directorate of Drawback. In case, the quantity imported is partially utilized, the same will be returned with requisite endorsement thereon.

CERTIFICATE

Certified that the particulars mentioned in this statement are correct to the best of my knowledge and belief and no claims for refund of duty in respect of any of the above mentioned materials/components procured against the Invoices and other duty paying documents mentioned in the Statement has been or will be lodged with the Central Excise Authorities. Further, the same Invoices/documents relating to payment of Central Excise duty have not been repeated or are intended to be repeated in future. In case the same have been used partially and the benefit of drawback has already been claimed in earlier Brand Rate applications or are intended to be used partially in future, the details thereof have been furnished in the annexure to the Statement.

Signature: Name: Designation Name & Address of the Institution under which Chartered . with Designation Registration No. & date of Membership (This is required to the certified / countersigned by a Chartered Accountant / Cost Accountant )

Signature: Name : Designation Address of the Power of Attorney Holder or Authorised Agent on behalf of the applicant

STATEMENT-DBK-III (A)

Details of procurement relating to stocks of indigenous materials as on commencement * date (* the date three months prior to the date of shipment/first shipment) based on FIFO principle, required for manufacture of __________________________________________________(Name of export product).

S.No.	Description	S.No.in DBK I Statement	Unit	Qty. purchased originally	Assessable value
1	2	3	4	5	6

Effective Rate of duty paid	Amount of duty paid	Name & Address of supplier	Gate Pass No. & date	Is assessment of duty final	Stocks as on	Remarks
7	8	9	10	11	12	13

Note:-

1. In this statement furnish details of stock of all the indigenous materials mentioned in statement I & III which were in stock three months prior to date of shipment/first shipment of the export product and how these were procured (including relevant Invoices/documents relating to payment of Central Excise duty may be furnished).

2. If the assessment is not final for a duty paid under protest the extent of dispute may please be clearly indicated.

3. Refund application made, if any, against any duty paying documents/Invoice details thereof may please be furnished.

4. In case, the indigenous items have been procured from a different individual/party who has paid the Central Excise duty, a requisite disclaimer may also be furnished, alongwith a declaration that no CENVAT benefit has been availed.

5. The Invoices ( in original) evidencing payment of Central Excise Duty are required to be attached. In case the quantity procured under payment of Central Excise Duty gets exhausted with this Brand Rate application, the same will be retained in the Directorate of Drawback. In case, the quantity imported is partially utilized, the same will be returned with requisite endorsement thereon.

CERTIFICATE

Certified that the particulars mentioned in this statement are correct to the best of my knowledge and belief and no claims for refund of duty in respect of any of the above mentioned materials/components procured against the Invoices and other duty paying documents mentioned in the Statement has been or will be lodged with the Central Excise Authorities. Further, the same Invoices/documents relating to payment of Central Excise duty have not been repeated or are intended to be repeated in future. In case the same have been used partially and the benefit of drawback has already been claimed in earlier Brand Rate applications or are intended to be used partially in future, the details thereof have been furnished in the annexure to the Statement.

Signature: Name: Designation Name & Address of the Institution under which Chartered . with Designation Registration No. & date of Membership ( This is required to the certified / countersigned by a Chartered Accountant / Cost Accountant )

Signature: Name : Designation Address of the Power of Attorney Holder or Authorised Agent on behalf of the applicant

ANNEXURE

Certificate to be appended by an independent Cost Accountant/Chartered Accountant at the end of Statements II and III.

It is certified that –

(a) We have checked the data contained in the Statements II & IIA, III and IIIA and it gives correct details of all stocks and procurements of the inputs used in the manufacture of the export product.

(b) We have checked the data contained in Statements II & IIA, III and IIIA with the original copies of the Bills of entry, stock register and original copy of the gate passes wherever claimed to be available and the same is found to be correct. The stock procurement of every input as claimed is fully supported by Bill of Entry for imported input and gate pass for the indigenous input in the name of the applicant as indicated in the Statements. Wherever there is no bill of entry or gate pass but the procurement is under invoices, the same have been clearly indicated in the statements II/III respectively.

(c) The materials for which data has been furnished in statement II, but no data has been furnished in Statement III, are only of imported origin and no procurements are being made from indigenous sources;

(d) The selling price of the recoverable wastages/co-product/bi-product as indicated in DBK-I have been verified with the sale invoices. These are in order and comparable to their current market price.

(e) The assessment documents (bills of entry/gate passes) have been finally assessed and the manufacturer has not claimed any refund of the duties paid on any of these documents.

(f) Wherever the assessments under any case are provisional or refund of duty claimed against a B/E/G.P. the same has been clearly indicated in related DBL II/III statements.

Signature . Name Designation . Address Name & Address of the Institution under which chartered

Reg. No………………………………………………………………………….
Place:
Date

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