FORM R-1

Application for Registration to cure/produce/manufacture/conduct wholesale trade/act as abroker or commission agent/obtain excisable goods, for industrial purpose etc.

[See Rules 174 and 192]

(Delete the letters and words not applicable)

To

        The Superintendent of Central Excise,

Sir,

        I/We___________________________________________________________________  Son/Daughter(s) of _____________________residing at__________________________________________hereby request that I/We ________________________________may be issued a registration certificate under Rule 174 for the purposes indicated in the schedule. Other details required are also furnished in the schedule.

2. I/We _________________________________agree to abide by all the terms and conditions of the registration which may be imposed from time to time.

3. I/We _______________________________________agree to abide by all the provisions of Central Excise Rules, 1944 and any orders issued there under.

4. I/We ________________________________________declare to the best of my/our knowledge and belief the information furnished herein is true and complete.
Place:
Date:

Signature of the applicant
(Signatures)

ACKNOWLEDGEMENT
Received an application for Registration from Ms./Mr./ Smt._______________________Son/Daughter of __________________________for registration under R. 174.

Date:

Rubber stamp of the
officer receiving the application.

SCHEDULE

1. Name and address of the personapplying for the registration :

2. Details of the premises where
the activity proposed is to be carried on :

(attach details of plan of Building/Plant/Machinery etc.)

3. Details of the proprietors/all partners/Directors of the company including:

(a) Name (s)

(b) Address (es)

(i)Official

(ii)Residential

(c) Income Tax No. / Nos.

4. SI. No.	Description of Excisable goods	Tariff Classification	The purpose for which the registration is sought for	Remarks

5. In case the application is for obtaining excisable goods to be used for specialindustrial purposes, additional details as below may be furnished.

(i) Estimated quantity of each case of :
goods and value of such goods likely
to be used during the year

(ii) Commodities to be manufactured and :
issue of each commodity during the
year

(iii) Manner of manufacture :

(iv) Purpose to which manufactured product :
is supplied

(v) Source from which excisable goods :
will be obtained

(vi) Remarks :

6. In case the application is for obtaining permission for warehousing, additionaldetails in the format furnished below may be given :

1. Village/town

2. District

Distinguishing letter or number or letter and number of each

Detailed  description of each

Purpose of each

3. Description of each main division or :
sub-division of the warehouse or
storeroom

4. Area and total storage capacity :

5. Varieties of excisable product :
to be stored

(6. **************)

7. Estimated quantity of each variety :
of such products to be stored during
each financial