FORM A-1
[Refer condition at S. No. 3 (II)(a)]
Declaration by the SEZ Unit or Developer for availing ab initio exemption under notification No.12/2013- Service Tax dated 1st July, 2013
1. Name of the SEZ Unit/Developer:
2. Addresses with telephone and Email:
3. Permanent Account Number (PAN) of the SEZ Unit/Developer:
4. Import and Export Code Number:
5. Jurisdictional Central Excise/Service Tax Division:
6. Service Tax registration number / Service Tax code / Central Excise registration number:
7. Declaration: I/We hereby declare that-
(i)The information given in this application form is true, correct and complete in every respect and I am authorised to sign on behalf of the SEZ Unit/Developer;
(ii)I/We maintain proper account of specified services, as approved by the Approval Committee of SEZ, received and used for authorised operations in SEZ; I/we shall make available such accounts and related records, at all reasonable times, to the jurisdictional Central Excise officers for inspection or scrutiny.
(iii)I/We shall use/have used specified services for authorised operations in the SEZ.
(iv)I/We declare that we do not own or carry on any business other than the operations in SEZ [where this item is not applicable, declaration may be submitted after striking out the inapplicable portion];
OR
I/We declare that we also own/ carry on any business in domestic tariff area as per the details furnished below:
Table I
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S. No. |
Name of the unit owned in DTA |
Output services provided by DTA Unit |
Goods manufactured by the DTA unit |
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(v)I/We are aware that the declaration is valid only for the purpose specified in notification 12/2013-Service Tax dated 1st July, 2013 and is subject to fulfillment of conditions.
(vi) I/We intend to claim ab initio exemption on the specified services mentioned in the following Table:
Table II
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Sl.No. |
Specified service(s) to be received for the authorised operation |
Details of service provider(s) who provide(s) the specified service(s), for SEZ authorised operations |
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Name and address |
Service Tax registration No./(“self” in case of service on which service tax is paid on reverse charge) |
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(1) |
(2) |
(3) |
(4) |
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(vii) I/We undertake that in case the services on which exemption has been claimed were not exclusively used for authorised operation or were found not to have been used exclusively for authorised operation, we shall pay to the government an amount that is claimed by way of exemption from service tax along with interest as applicable on delayed payment of service tax under the provisions of the said Act read with the rules made thereunder.
Signature and name of authorised person with stamp
Date:
Place:
I have verified the above declaration; it is correct
Signature, date and stamp of the Specified Officer of the SEZ Unit /Developer (Specified Officer shall retain a copy of the verified declaration, for the purpose of record)
FORM A-2
[Refer condition at S. No . 3 (II)(b)]
Authorisation for procurement of services by a SEZ Unit/Developer for authorised operations under notification No.12/2013 - Service Tax dated 1st July, 2013
A: Details of SEZ Unit/Developer:
1. Name of the SEZ Unit/Developer:
2. Address of the SEZ Unit/Developer with telephone and email:
3. Permanent Account Number (PAN) of the SEZ Unit/Developer:
4. Import and Export Code Number:
5. Jurisdictional Central Excise/Service Tax Division:
6. Service Tax registration number/Service Tax Code /Central Excise registration number:
B: The details of specified services that the SEZ Unit/Developer is authorised to procure in terms of declaration furnished by the SEZ Unit /Developer
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Sl.No. |
Specified service(s) to be received for the authorised operation |
Details of service provider(s) who provide(s) the specified service(s), for SEZ authorised operations |
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Name and address |
Service Tax registration No. |
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(1) |
(2) |
(3) |
(4) |
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(Signature and the stamp of the jurisdictional Deputy Commissioner of Central Excise/Assistant Commissioner of Central Excise)
Phone No:
Fax No.:
FORM A-3
[Refer condition at S. No . 3 (II)(d)]
Quarterly return to be furnished by the SEZ Unit/Developer furnishing the details of services procured without payment of service tax in terms of the notification No. 12/2013 - Service Tax dated 1st July, 2013
For the Quarter: April-June/Jul-Sep/Oct-Dec/Jan-March Year:
[Tick the appropriate quarter]
1. Name of the SEZ Unit/Developer: 2. Address of the SEZ Unit/Developer with telephone and email: 3. Permanent Account Number (PAN) of the SEZ Unit/Developer: 4. Import and Export Code Number: 5. Jurisdictional Central Excise/Service Tax Division: 6. Service Tax Registration Number/Service Tax Code/Central Excise registration number: 7. We have procured the services as per the details below without payment of service tax in terms of notification No. 12/2013- Service Tax dated 1st July, 2013
TABLE
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S. No. |
Description of taxable service |
Name and address of service provider |
Registration of service provider |
Invoice No. |
Date |
Value ofservice |
Service tax + cess amount claimed as exemption |
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(1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
(8) |
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Signature and name of authorised person with stamp
Date:
Place:
FORM A-4
[Refer condition at S. No. 3 (III)(c)]
Application for claiming refund of service tax paid on specified services used for authorised operations in SEZ under notification No.12/2013- Service Tax dated 1st July, 2013
To
The Assistant/Deputy Commissioner of Central Excise/Service Tax ___________ Division, _______ Commissionerate
Sir,
I /We having details as below,-
(i) Name of the SEZ Unit/Developer:
(ii) Address of the SEZ Unit/Developer with telephone and email:
(iii) Address of the registered/Head Office with telephone and email:
(iv) Permanent Account Number (PAN) of the SEZ Unit/Developer:
(v) Import and Export Code Number:
(vi) Jurisdictional Central Excise/Service Tax Division:
(vii) Service Tax Registration Number/Service Tax Code / Central Excise registration number:
(viii) Information regarding Bank Account (Bank, address of branch, account number) in which refund amount should be credited/to be deposited:
(ix) Details regarding service tax refund claimed:
claim refund of Rs.................. (Rupees in words) as per the details furnished in the Table I and Table II below for the period from____________ to______________.
(A) Refund of service tax in respect of service tax paid on specified services exclusively used for the authorised operations in SEZ, as approved by the Approval Committee of the _________ SEZ [ Rupees____________] as per the details below
Table-I
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S. No. |
Description of taxable service |
Name and address of service provider |
STC No. of service provider (Indicate “ self” if reverse charge applies to the specified service) |
Invoice* No. |
Date |
Value of service |
Service tax +cesses paid |
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(1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
(8) |
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Total amount claimed as refund |
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*Certified copies of documents are enclosed.
(B) Refund on respect of service tax paid on specified services other than the services used exclusively for authorised operation (used partially for the authorised operations of SEZ Unit/Developer), as approved by the Approval Committee of the _________ SEZ [Rupees ____________].
Table-II
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S. No. |
Description of taxable service |
Name and address of service provider |
STC No. of service provider |
Invoice* No. |
Date |
Value of service |
Service tax + cess Amt |
Amount distributed to the SEZ Unit/Devel-oper out of the amount mentioned at column No. (8) |
Document* under which amount mentioned at column (9) was distributed to the SEZ Unit/Developer |
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(Claimed as refund) |
No. |
Date |
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(1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
(8) |
(9) |
(10) |
(11) |
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Total Amount |
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*Certified copies of documents are enclosed
2. (i) The turnover of the authorised operation of the SEZ Unit/Developer in the previous financial year:________________________;
(ii) Turnover of the DTA operations in the previous financial year:____________
3. I/We Declare that-
(i) information given in this application for refund is true, correct and complete in every respect and that I am authorised to sign this application for refund of service tax;
(ii) the specified services, as approved by the Approval Committee of SEZ, on which exemption/refund is claimed are actually used for the authorised operations in SEZ;
(iii) we have paid the service tax amount along with the cesses, being claimed as refund vide this application, to the service provider;
(iv) refund of service tax has not been claimed or received earlier, on the basis of above documents/information;
(v) we have not taken any CENVAT credit under the CENVAT Credit Rules, 2004 of the amount being claimed as refund;
(vi) proper account of receipt and use of the specified services on which exemption/refund is claimed, for the authorised operations in the SEZ, is maintained and the same shall be produced to the officer sanctioning refund, on demand.
Signature and name (of proprietor/managing partner/ person authorised by managing director of the SEZ Unit/Developer) with complete address, telephone and e-mail.
(This FORM A-1,2,3,4 vide NTF. NO. 12/2013-ST, DT. 01/07/2013 )
(For OLD FORM A-1,2,3,4 refer NTF. NO. 40/2012-ST, DT. 20/06/2012)