ANNEXURE 64

Intimation in respect of duty paid excisable goods brought into the factory premises under Rule 16 of Central Excise Rules, 2002

The Superintendent of Central Excise,
............................Range

I hereby declare that the under mentioned consignment of excisable goods has been received by me/ us at our licensed premises on .............................. at ................................. hrs for the purpose of ..............................................

Name and address of the supplier of the goods	No. and date of challan under which goods are received	Description and variety of goods	No. of packages received with identification marks	Quantity as shown in the challan	Quantity received	Tariff Item No. and invoice / gate pass No. under which duty was paid, if any	Detail of certificate reg. duty paid value of goods from the supplier of the goods sent for reprocessing
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)

I/ We declare that the goods received are identifiable with the description given in the challans to my/our entire satisfaction. The goods will be reprocessed and removed within six months period from the date of receipt. I/ we have entered the particulars of the consignment in my/our Register / records separately maintained for the purposes.

Signature of the Licensee or
his Authorised Agent]