FORM ER-5

{sub-rule (1) of rule 9A of CENVAT Credit Rules, 2004}

1. Name of the manufacturer:2. PAN based Registration Number:			ccccccccccccccc3.  Annual Declaration 	(i) New declaration	(ii) Amendments to declaration already filed	(Pl. tick the appropriate box)4. Declaration for the Financial Year ___________

S.No	Description of principal inputs	Central Excise Tariff Sub-HeadingNo. of principal inputs	Quantity code*	Description of finished goods in which principal input mentioned in column (2) is used	Central Excise Tariff Sub-Heading No. of finished goods	Quantity code*	Quantity of principal input mentioned in column (2) required for use in the manufacture of unit quantity of finished goods mentioned in column (5)
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)

*NOTE. - Please indicate the abbreviation referred to in Instruction No. 7 mentioned in Form E.R.-1 and Form E.R.-3 specified in the Government of India, Ministry of Finance (Department of Revenue) vide No.25/2004-Central Excise (N.T.), dated the 27th September, 2004 published vide G.S.R.No.643 (E) dated the 25th September, 2004.

5. (i) I/We _________________hereby declare that the information given above is true, correct and complete in every respect to the best of my/our knowledge and belief.

(ii) I/We am/are authorized to sign this declaration.

(Name in capital letters and signature
of the assessee or authorized signatory)

Place:

Date:

ACKNOWLEDGEMENT

Declaration for the Financial Year ___________

D

D

M

M

Y

Y

Y

Y

Date of receipt

Place:

Date:

Name and signature of the officer with seal

NTF. NO. 40/2004-CE(N.T.), DT. 25/11/2004