Central Excise Series No. 57
FORM A.R. 1
Application for removal of excisable goods on payment of duty
(In triplicate)
Rules 9, 9B, 52,80,93 and 158
Name and address of owner__________________________________
| No. and Date of entry in warehouse Register or Entry Book, if any | No. Description of packages | Gross weight of packages | Marks and Numbers | Descriptions of goods with tariff classification | Weight or Quantity | Real Value | Invoice Value | Tariff Value | Duty | No.(s) and date(s) of gate-passes issued under rule 52-A | Remarks |
| Rate | Amount | Rate | Amount | Rate | Amount | Rate | Amount |
| | | | | | | | Rs.P. | | Rs.P. | | Rs.P. | | Rs.P. | | |
| 1 | 2 | 3 | 4 | 5 | 6 | 7(a) | 7(b) | 7(c) | 8 | 9 | 10 | 11 |
NOTES:- Where additional excise duty is also leviable, separate entries for basicand additional excise duties should be made on different horizontal lines and the amounts totalled. Separate entries should similarly be made in columns 2,3 and 4 of Part I of the Statement of duty paid (on the reverse).
- Real value is the value referred to in section 4 of the Central Excise Act, 1944.
- Invoice value is the value specified by the manufacturer or producer to thecustomer. This value should be given in all classes.
- Tariff value is the value fixed by the Central Government under section 3 ofthe Central Excises and Salt Act, 1944. This column should be filled in whereverapplicable.
< Assessment Memorandum Declaration (To be entered in words and figures) I/We declare the above particulars to be true 1. Total number of packages .............. and correctly stated.2. Quantity of goods on which duty is assessed............................3. Rate of duty...........................4. Total duty payable..................... I/We apply for leave to clear the above goods. Signature.................. ............................ ..........of Central Excise Signature of the owner or his authorised agent Place............... Place................Date................ Date................. Statement of duty paid at............. Treasury Sub-Treasury State Bank of India Reserve Bank of India I. For payment in cash (To be filled in by the owner or his authorised agent.)
| Name of the person tendering payment | Name and Address of person on Whose behalf The amount is Tendered | Particulars of payment | Amount
Rs. P. | Head of Account |
| 1 | 2 | 3 | 4 | 5 |
(1) Excise duty on 038- UNION EXCISE DUTIES(2) Additional Duties of Excise under the Additional Duties of Excise (Goods of Special Importance) Act, 1957 Textiles -Cotton/Woollen/Silk/ Artificial: -Silk, Tobacco -Unmanufactured Tobacco/ Cigarettes/Cigars and Cheroots, Sugar (in words) Rupees.........................TotalDate................. Signature of tenderer.................... (to be filled in by Treasury of Bank) Certificate Received payment of Rupees............... ..............................(in words) Signature of Treasury.................... Accountant...............................Date............... Treasury Officer......................... Agent or Manager.........................II. For payment through Current Account
| Title of Account or Ledger Number | Number and date of Entry | Amount
Rs. P. |
Date................... Signature of the owner or his authorised agent III. For payment by Money Order
| Number and date of Money Order (Receipt to be attached to original application) | Amount
Rs. P. |
|
Date.................Clearance allowed Signature of the owner or his Number and date of transport permit, authorised agent if any Signature......................... Date................. ...............of Central Excise