APPENDIX - 17
APPLICATION FORM FOR CLAIMING DUTY DRAWBACK ON ALL INDUSTRY RATES/ FIXATION OF DRAWBACK RATES/REFUND OF TERMINAL EXCISE DUTY.
Note:
- Please see Paragraph 10.3 of the Policy and Paragraph 10.15 of this Handbook.
- Please read the general instructions given at Appendix 1 also before filling this application.
FOR OFFICIAL USE
File No.:-------------------------------- Date:----------------------------
PART-A
1. Name of the applicant firm : ....................................
1. IEC Number : ....................................
2. Name & Address of the factory where the product
supplied is being manufactured (alongwith Central
Excise Licence No., if any) : ....................................
3A. Name of the firm/Co./ Project authority to whom
supplies have been made or product supplied. : ....................................
3. Description, quality and the technical
characteristics of the product supplied. :....................................
4. a) FOB & FOR value of the export in : ....................................
the preceding three years (yearwise)
b) Value of the total production of the : ....................................
product for the preceding three years
(yearwise).
6. a) Sub-serial number of the drawback : ....................................
schedule under which the product
supplied is classified.
b) If All Industry rate of Drawback is available, : ....................................
Serial No. and rate of DBK.
7. Net weight of the product per unit, where unit is
other than by weights. : ....................................
8. Current F.O.R. Price of the product supplied. : ....................................
9. The Central Excise Tariff. Chapter/ Heading in
which classified and rate of Central Excise
duty payable on the supplied product. : ....................................
10. State the mode of supplies : : ....................................
a) Whether under Central Excise Bond : ....................................
b) After payment of duty under claim of
rebate of Central Excise Duty. : ....................................
c) Otherwise. : ....................................
(Strike out whichever is inapplicable)
11. Whether in respect of any of raw materials/
components the benefits under Rules 12A,12(1)
(b) & 13 (1)(b) or any other Central Excise Rules
is being availed of, if so the details thereof in
respect of each input/raw material. : ....................................
12. Whether in respect of any of the raw material/
components MODVAT benefits under Rule 57A
of the Central Excise Rule is being availed of?
if so the details thereof in respect of each
input/ raw material. Whether any declaration
has been filed in terms of Rule 57(g) (1) of
Central Excise Rules for availing MODVAT benefits
under Rule 57A If so details of inputs for which such
benefit claimed(Furnish details of credit in
relevant DBK-IIA/III A statements attached). : ....................................
13. Whether benefit of Engineering Products Export
(Replenishment of Iron Steel Intermediate)
Scheme or any other Scheme for supply of raw
materials at international prices is being availed
of for any of the inputs for the manufacture of
the export product (if so furnish details). : ....................................
14. Whether the benefits of ITC PN-56/72 and
78/72 are being availed of in respect of any raw
materials imported. : ....................................
15. Whether any other benefit under any of the
Customs and/or Central Excise Notification is
being availed of in respect of the raw materials
components and other inputs used in the
product supplied. : ....................................
16. Whether in respect of the imported material: : ....................................
a) The benefits of duty exemption Scheme : ....................................
is being availed of. If so, the details of the
same (Viz: DEEC/DEPB/DFRC Number & date
or application number and date for
DEEC/ DEPB/DFRC as the case may be and
the inputs for which DEEC/DEPB/ DFRC facility
is being claimed. A photocopy of the DEEC
/DEPB/DFRC to be attached/ forwarded)
(b) manufacture under bond procedure in
terms of Section 65 of Customs Act, 1962
is being followed; if so, the details thereof.
b) If yes, then did you declare this DBK claim : ....................................
in Advance Licence for deemed exports
application also.
PART-B
For fixation of Duty Drawback rates under Rule 6(1)(a) or Rule 7(1) of Drawback (Strike out whichever is not
relevent).
17. (a) The drawback rate (or amount) expected
(Enclose working sheet in support thereof). : ....................................
(b) In case the application is for fixation of special
brand rate under Rule 7(i) of the Drawback
Rules, is the rate indicated in S.No.5 less
than four-fifth of the rate indicated in
Col.16(a) above. : ....................................
(c) In case the application is for fixing of Brand
Rate under Rule 6 of the Drawback Rules, is
the rate worked out as at 16(a) above more
than 1% of FOR Value, if so the percentage
of Drawback Rate Expected to FOR value. :....................................
18. (a) Is the FOR value with regard to each item
in the Supply Invoice less than the value
of all imported materials used in the
manufacturing of such goods ? :....................................
(b) If not, what is the percentage of value
addition against each entry in the supply
Invoice. :....................................
19. Brief Process of manufacture, (Enclose Catalogue/
literature, etc. of the items of Export. :....................................
PART-C
(For Refund of Terminal Excise Duty)
20. The Central Excise tariff Chapter/ Heading in
which classified & rate of Central Excise Duty
payable on the product supplied. :....................................
21. Central Excise Invoice and corresponding RT
– 12 showing amount of Terminal Excise Duty
paid or self certified Invoice showing the amount
of Terminal Excise Duty paid :....................................
DECLARATION/UNDERTAKING
- I/We hereby declare that the particulars given above as well as in accompanying Statements DBK I to III are correct to the best of my/our knowledge and belief and that no separate application in respect of the same goods has been submitted so far.
- I/We full understand that any information furnished in the application if proved incorrect or false will render me/us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.
- I/We undertake to abide by the provisions of the Foreign Trade(Development and Regulation) Act, 1992, the Rules and Orders framed thereunder, the Export and Import Policy and the Handbook of Procedures.
- I/We also declare that I/We shall intimate any change (including receipt of suo-motto refunds) in the particulars as mentioned in the proforma and statements submitted within one month from the date of such change and I/We agree to any consequential change in the Drawback Rates with effect from the date of changed Drawback Rates are allowed and shall on demand by an Officer of DGFT/D.C. repay the amounts received in excess.
- I/we further declare that I/We shall immediately refund the amount of drawback obtained by us in excess of any amount/rate which may be re-determined by Government as a result of post verification.
- I/We further declare that no export proceeds are outstanding beyond the prescribed period as laid down by the RBI ,or such extended period for which RBI permission has been obtained.
- I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 3.8 of the Policy.
Signature of the Applicant:______________
Name : _______________________
Designation : _______________________
Official Address: _______________________
_______________________
Tele.No.: _____________________________
Place: Residential Address: ____________________
Date : ____________________
E.Mail address _________________________
Documents to be enclosed with the application form:
A. FOR REFUND OF TERMIAL EXCISE DUTY :
i) Application in Appendix 17.
ii) Supply invoices certified by Project Authority/self certified or Excise Attested Invoices.
In case of 100% EOUs/EPZ/STP/EHTP units, a complete AR-3A/ supply invoice certified by
the bond officer is to be furnished.
(In above Appendix A ii) has been amended vide PN.No. 43(RE-01), DT. 19/10/2001.)
iii) Payment certificate issued by the Project Authority as per Appendix 14B. For supply to EOU/EPZ
units the certificate to be given regarding receipt of payment through normal banking channel in
the form given in Appendix- 25A. However, in respect of supplies under paragraph 10.2 (d),(e),(f)
and (g), wherever eligible for refund of TED, if the applicant is not able to furnish payment certificate,
he may alternatively furnish the copies of the excise invoices showing the receipt of the material by
the Project Authority duly countersigned by the authorised person for this purpose as given in note
(3)of Appendix–14A, in lieu of payment certificate. In such cases, the applicant shall furnish the
copies of the excise invoices showing the receipt of the material by the Project authority duly
countersigned by the authorised person for this purpose as given in note (3) of Appendix-14A in lieu
of payment certificate.
iv) Photocopy of complete A.R.O./Back to Back LC/DEEC (in case of Advance Licence for deemed Export)
v) Photocopy of the purchase order/L.O.I/contract (self certified).
vi) Original input stage Invoices with corresponding RT-12 duly certified by Excise authorities or self
certified invoice showing the Terminal Excise Duty paid.
vii) In respect of supplies under paragraph 10.2(d), (e) (f) and (g), the applicant shall furnish a copy of
the project authority certificate as given in Appendix-14A.
ADDITIONAL DOCUMENTS REQUIRED WHEREVER BRAND RATE OF DUTY DRAWBACK IS BEING CLAIMED
i) DBK I duly certified by a Chartered Engineer.
ii) DBK II, IIA, III & III-A, duly certified by a Chartered Accountant alongwith non-availment of MODVAT
Certificate from the jurisdictional Excise Authorities.
iii) Photocopies of Bill of Entries alongwith relevant Import Invoices.
iv) In respect of supplies under paragraph 10.2(d), (e) (f) and (g), the applicant shall furnish a copy of
the project authority certificate as given in Appendix-14A.
- Note:
- In case of public sector undertaking, the DBK statements may be signed/ certified by the Head of Production and Head of Finance department.
STATEMENT - DBK-I
Description of the Export Product supplied...................Bill of Materials* issued for manufacture of (No.of units of the export product).
*(Bill of materials should consist of raw materials and components going into the manufacture of export product supplied and the actual packing materials used).
| S.No. | Name of the material/ component | Quality | Technical characteristics | Whether imported or indigenous | Unit | Gross qty. required | Wastage Qty Irrevo recover
Cable able |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| | | | | | | | | |
| Sale Price of waste per unit of Qty | By Product/ co product | Net wt of the material | Remarks |
| | Qty. | Sale value per unit | | |
| 10 | 11 | 12 | 13 | 14 |
Give convenient units by which goods are invoiced for export (e.g. per tonne, per dozen/Pcs., per Sq. meter etc).
Notes:-
- The Units of quantity to be furnished in Col.6 should be given in such a manner that it could be related to Statements II and III respectively.
- Maintenance stores/materials such as lubricating oil, greases, fuel etc. which are employed to run the machinery and plant should be excluded.
- The data for packing materials should be for the same unit quantity for which data for export product for raw materials and components have been given.
- Only those raw materials/components etc. to be indicated for which proof of payment of Customs/Central Excise duties is shown in DBK-II/III. Details of such inputs need not be given where no benefit of duty paid is claimed because of MODVAT or absence of proof of duty. Only a brief mention of such inputs being used would be sufficient.
CERTIFICATE REQUIRED FOR DBK-I STATEMENT
1. On behalf of the applicant, I hereby certify that the materials as mentioned above are actually required
and being used for production of export product.
Station _____________ Signature _________________
(Name & Designation of the Chief
Dated _____________ Executive/Production incharge
(with seal.)
II. It is certified that (To be given by an independent Chartered Engineer):
a) The consumption of various materials shown in DBK-I has been examined by us and these are actually
required and being consumed in the factory of production for manufacture of export product supplied
as checked by us on verification of the production process and relevant technical and related
documents.
b) The imported materials above shown in DBK-I are being actually used in the manufacture of the export
product supplied and are not being substituted by indigenous materials;
c) The wastage /co-product/by-product claimed are as per production process in the factory. There is no
suppression of co-product/by-products. The wastages claimed in our views are reasonable and are
comparable to the general norms for the industry. Where wastages are considered high, an indication
of the normal wastage in the industry has been indicated by us, under "Remarks" column.
Signature__________________________
Name_______________________________
Designation________________________
Address____________________________
Place___________ Branch of Engg.
Date____________ in which qualified:________________
Name & Address of the institution : ___________________________________
under which Chartered.Ref.No.and date ____________________________________
of membership. ____________________________________
STATEMENT - DBK - II
Direct import of materials/components made by the manufacturer and foreign materials obtained locally by the
manufacturer during the period commencing three months prior to the date of supply /first supply upto the date
of application, for manufacture of ______________________ (Name of export product supplied).
| S.No. | Description | Techni-cal charac-terist-ics | S.No. in DBK 1 statement | B/E No. & date under which imported | Name of the Customs House | Unit | Qty. imported originally | Assessable value |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| | | | | | | | | |
| Heading No. in Customs Tariff Act, 1975 | Rate of duty | Country from which imported and name of supplier | Is assessment final | Basic duty + Additional Customs Duty | Name and full address of the supplier in case the foreign material/Components obtained locally | remarks |
| 10 | 11 | 12 | 13 | 14 | 15 | 16 |
| | | | | | | |
Notes:
1. If any of the materials mentioned above have also been procured from indigenous origin, this must be
specifically stated in remarks column and full details of the procurement alongwith proof of payment
of duty should be furnished in DBK-III statement, even if it is claimed that they are not used in the
products exported.
2. Minor items which do not contribute to any significant proportion to the expected drawback rates may
be ignored, at the discretion of the applicant.
3. If the assessment against any B/E is not final the nature of dispute may be clearly indicated supported
by appropriate letter from concerned customs authorities. Normally no DBK is admitted for provisionally
assessed B/Es.
4. Refund application made against any B/E, with details must be indicated.
5. Stock position of the above materials/Components also to be given separately (in linked statement II-A).
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 bills of entries (other than whose
details are furnished) has been or will be lodged with the customs Authorities.
Signature and Stamp of independent Signature _________________
Chartered Accountant/Cost Accountant (Name & Designation of the Chief
Executive/ Production incharge
(with seal.)
STATEMENT - DBK - IIA
Details of procurements relating to stock of imported materials as on commencement *date (*the date three
months prior to the date of supply /first supply required for the manufacture of _______________________
(Name of export product supplied).
| S.No. | Description | Techni-cal Characteristics | S.No. in DBK I statement | B/E No. and date coveringthe imported stock | Name of the Customs House | Unit | Qty. imported originally | Assessa-ble value |
| 1 | 2 | 3 | 4 | 5 | 6 | 6A | 7 | 8 |
| | | | | | | | | |
| Heading no. in Customs tariff Act, 1975 | Rate of duty | Country from where imported & name of supplier | Is assesment final | Basic duty + Addl customs duty | Name and full address of the supplier in case the foreign materials/components obtained locally | Stock as on ___ | Remark |
| 9 | 10 | 11 | 12 | 13 13A | 14 | 15 | 16 |
| | | | | | | | |
Note:-
- In this statement furnish details of stock of all the imported inputs mentioned in statements II which were in stock 3 months prior to the date of shipment/first shipment of the export product and how these were imported/procured. (Actual stock to be given under Col.15, with procurement details in other Columns).
- If the assessment for any of the inputs in stock as shown is not final, the nature and current status of dispute may be clearly indicated. (Normally no DBK for provisionally assessed B/E are admitted).
- Refund applications made if any for procurement shown in stock with details to be indicated.
- Photocopies of all Bills of Entries mentioned above must be enclosed.
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 bills of entries has been or will be
lodged with the Customs Authorities.
Signature and Stamp of independent
Signature
Chartered Accountant/Cost Accountant
STATEMENT - DBK - III
Materials/Components of Indian Origin obtained by the manufacturer during the period commencing three months
prior to the date of supply /first supply upto the date of application for the manufacture of ___________
_________ (Name of export product supplied).
| Sl.No. | Description | Technical Characteristics | S.No. in DBK-I statement | Unit | Qty purchased | Assessable value | Central excise tariff Heading no. |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| Effective rate of duty paid | Amount of duty paid | Name and address of supplier | Invoice No.and date | Is assessment on duty final | Remark |
| 9 | 10 | 11 | 12 | 13 | 14 |
Notes:-
- In this statement details of only those items which are chargeable to the excise duty to be given for which proof of Central Excise duty can be established by Invoices.
- Materials/Components specified in Drawback II Statement if these are also of indigenous origin and procured locally should be included in this statement, whether dutiable or not. This is irrespective of the fact whether the said materials/components are used for export production or not. Where the said materials/components are claimed to be only for manufacture of goods for local sales and not for exports, this should be specifically indicated in the "Remarks" column, against the respective serial number of the said material/component.
- The particulars of Invoice numbers and date where the applicant is the consignee should be furnished under col.11. Photocopies of all Invoices for inputs which are subject to Central Excise Duties of 20% or higher and some representative copies for other Invoices must be enclosed.
- If the assessment which is not final or duty is paid under protest the extent of dispute may please be clearly indicated ( copy of S V B Order to be attached.
- Refund applications made if any against any Invoice with Details, to be indicated.
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 Invoices/ subsidiary Invoices has been or will be lodged with the Central Excise Authorities.
Chartered Accountant/Cost Accountant
Signature and Stamp of independent Signature
(Name & Designation of
the Chief Executive/
Production Incharge
(with seal.)
STATEMENT - DBK - III(A)
Details of procurements relating to stocks of indigenous materials as on commencement to (the date three
months prior to the date of supply/first supply)
| S.No. | Description | Technical Characteristics | S.No. in DBK-I statement | Unit | Qty purchased originally | Assessable value | Central Excise Tariff heading no. |
| 1 | 2 | 3 | 4 | 4A | 5 | 6 | 7 |
| | | | | | | | |
| Effective rate of interest | Amount of duty paid | Name and address of supplier | Invoice No. and date | Is assessment of duty final | Stocks as on _____ | Remark |
| 8 | 9 | 10 | 11 | 12 | 13 | 14 |
| | | | | | | |
Notes:-
1. In this statement furnish details of stock of all the indigenous materials mentioned in statements 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 Invoices Nos.etc.).
1A. In this statement details of only those items which are chargeable to the Excise Duty may be given for
which proof of payment of Central Excise duty can be established.
2. The particular of Invoice number, date etc. should be furnished in Column.11.
3. If the assessment which is not final or duty is paid under protest the extent of dispute may please be
clearly indicated.
4. Refund applications made if any with details to be indicated.
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 has been or will be
lodged with the Central Excise Authorities.
Station: Signature and Stamp of Signature ________
independent/
(Name & Designation of
Date Chartered Accountant/ the Chief Executive/
Cost Accountant Production Incharge
(with seal)