FORM D-3

Declaration of receipt of excisable goods

Printed Serial No. ....................

(See Rules 173-K, 173-L, 173-M and 173-N)To

The Inspector of Central Excise,
..................................................

Sir,

I/We hereby declare that the under mentioned consignment of excisable goods has beenreceived by us at our licensed premises on......... 19........... at............ hours.

1. under claim for proforma credit under Rule 173-K;
   
2. for being remade, repaired or reconditioned under Rule 173-L/173 M;
   
3. in bond.

Name, address and licence No. of consignor	No. and date of gate pass duty-paid/ non-duty-paid	Description and variety of goods	Quantity as shown in gate pass	Shortage detected on receipt, if any

2. I/We declare

1. that the goods received are identifiable with thedescription given in the gate pass to my / our entire satisfaction.
   
2. that the majority of the unit or smallest packages, as the case may be, meantfor retail sale, are in intact and unopened, and in the case of opened packages,the goods are identified to my / our satisfaction on the basis of marking on theindividual articles or containers and/ or other collateral evidence, if any;
   
3. that the defect or deterioration resulted from defect in manufacture orstorage or due to some accident while in transit and that the goods have notbeen made use of in any manner except for trial purpose; and
   
4. that I/we have entered the particulars of the consignment so received in my / our relevantstock register.

Place:
Date:

Signature of Licensee or his authorised agent.
Name and address of Licensee.

Time of sending intimation