(Note:- Substituted vide Ntf. No. 65/2001-CE(NT), 17/10/2001)

"Annexure I

Original
Duplicate

FORM A-1

REQUEST FOR CENTRAL EXCISE REGISTRATION

Complete this Form for Registration with the Central Excise Department under provisions of rule 9 of the Central Excise (No.2) Rule, 2001. For more information, refer to the said rule and relevant instructions.

PART-I. Identification of Business requiring registration (manufacturing, warehousing, dealer in CENVATABLE goods)

1. Legal Name of the Business

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2. Permanent Account Number (PAN) (Issued by the Income Tax Department) (Self-attested copy to be enclosed)

3.

Specify (Tick the box):

Manufacturer c

Warehouse c

Manufacturer’s Depot c

Dealer c

4. Address of the Business

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Telephone Nos.

Fax Nos.

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E-mail Address

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5. Define boundaries of the premises to be registered

6. Address of Head Office, if any

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Telephone Nos.

Fax Nos.

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E-mail Address

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7. Name, designation and address of contact person/authorised person:
Last Name	First Name	Middle Name

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Designation

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Permanent Account Number (PAN) (Issued by the Income Tax Department) Address

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Telephone Nos.

Fax Nos.

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E-mail Address

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PART – II. Registration number and other details of OTHER existing businesses

1.

Specify (Tick the box):

Manufacturer c

Warehouse c

Manufacturer’s Depot c

Dealer c

2. Registration Number

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3. Legal Name of the Business

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4. Address of the Business

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Telephone Nos.

Fax Nos.

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E-mail Address

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Please furnish the aforesaid information for each of the other such factory(ies)/warehouse(s)/ dealer’s premise(s).

PART – III. Details of Proprietor/Partners/Directors and Managing Director

1.

Individual’s - Permanent Account Number (PAN) Proprietor c

Partner c

Director/Managing Director c

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Last Name

First Name

Middle Name

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Address

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PART – IV. History

1.

Has the applicant ever owned any business in the past? A. Name of Business (es)

Yes c

No c

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B. Previous Permanent Account Number (s)(PAN) and/or Registration Number(s)/Declarant Code Number(s): cccccccccc PAN

Registration Number

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2. Address

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Telephone Nos.

Fax Nos.

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E-mail Address

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3.	Has any other manufacturing business(es) existed in the past on the premises for which the current
	registration for manufacturing is being sought?	Yes c	No c

If yes, provide the following details:

A. Legal name of Business

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	B. Whether the said Business was registered or not with the Central Excise Department or was having Declarant Code Number?
	Yes c	No c	Not Known.c

If yes, provide registration number(s)/Declarant Code(s) (Whether based on PAN or otherwise):

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PART – V. Major Excisable goods to be manufactured, warehoused or traded

1._________________________

2._________________________

3._________________________

Declaration
I hereby declare that the information given in this Form is true, correct and complete in every respect. I would like toreceive the Registration Certificate (Tick appropriate box):

c By mail at the address specified at Sl.No. c of Part-I

c By Hand

Date:

Place:

(Name and Signature of the Applicant/authorised person with stamp)

Acknowledgement

I hereby acknowledge the receipt of your application for Registration. This is to inform you that you have been
registered with the Central Excise Department and your Registration Number is	cccccccccc cc ccc

This number has been allotted on the basis of the information furnished in your application. Your RegistrationCertificate will be provided within 7 working days from today.

Signature of the Superintendent/Inspector of Central Excise Officer
(with Name & Official Seal)

Document Locator Number ___________________
(To be mentioned on the Department’s copy for official purposes)
INSTRUCTIONS
1. Application has to be filed in duplicate and submitted in the Range Office having jurisdiction over the place of business.

2. Use separate Forms for separate registrations.

3. Acknowledgement and Registration Number shall be given instantly on the Original copy. The Registration Certificate willbe given within seven working days.

4. In the Form, “Legal Name of Business” refers to the name appearing on the Permanent Account Number (PAN) card/letterissued by the Income Tax Department

5. The expression “Business” used in the Form shall mean manufacturing unit/depot of a manufacturer/warehouse/registereddealership for the purposes of CENVAT.

6. Attach separate sheets for furnishing any information if the space provided in the Form is not sufficient

7. If an authorised person signs this Form, her/his details shall necessarily be provided at serial number 7 of Part I.

8. This Form should also be used to notify the Department of any change in the information subsequent to registration.

9. Document Locator Number will be specified by Range office on duplicate copy for internalrecords.";

(b) for Annexure-II, the following shall be substituted namely: -

"Annexure-II

Form RC

Central Excise
Registration Certificate

[Under Rule 9 of the Central Excise (No.2) Rules, 2001]
This is to certify, subject to conditions specified below, that M/s___________________________________ (Legal name),a ____________________________(its constitution) is registered for________________________(Type of business)at______________________________________________________________ (address of the Business Premises)on the basis of the application received in this office on ______________________ (Date of receipt).

Registration Number is cccccccccc cc ccc

Signature of the Superintendent of Central Excise
(With Name and Official seal)

Conditions

(i) This Registration Certificate is valid only for the premises and purposes specified in the application.

(ii) Registration Certificate is not transferable.

(iii) No corrections/changes in the Registration Certificate will be valid unless request for any correction/change is applied for andattested by the Superintendent of Central Excise.

(iv) This Registration Certificate shall remain valid till the Registrant carries on the activity for which it has been issued orsurrenders it or till it is revoked or suspended.

(v) The grant of this Registration Certificate shall be without prejudice to the rights of any other person(s) over the registeredpremises or purpose to which such person may be lawfully entitled.”;

2. This notification shall come into force on 1st November, 2001.
F. No. 201/12/2001-CX.6

(Vivek Prasad)
Under Secretary to the Government of India

Note: The principal notification No. 35/2001-CE(N.T.), dated 26th June, 2001, G.S.R. 464(E) dated 26th June, 2001 waspublished in the Gazette of India.

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