Note:
1. Please see Paragraph 10.3 of the Policy and Paragraph 10.15 of this Handbook.
2. Please read the general instructions given at Appendix 1 also before filling
this application.
3. In addition to this application form, please also submit Appendix-1 A (in
duplicate) alongwith this application.
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FOR OFFICIAL USE
File No. :-------------------------------- Date :-----------------
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PART-A
1. Name of the applicant firm : ________________________
2. IEC Number : ________________________
2A. PAN Number : _________________________
3. Name & Address of the factory where the : ________________________
product supplied is being manufactured : ________________________
(alongwith C. Excise Licence No., if any) : ________________________
3A. Name of the firm / Co. / Project authority to : ________________________
whom supplies have been made or product
supplied.
4. Description, quality and the technical : ________________________
characterstics of the product supplied
5. a) Quantity and f.o.b. & FOR value of : ________________________
the export of the past last three
years ( yearwise)
b) Quantity and value of the total : ________________________
production of the product for
the past three years (yearwise)
6. a) Sub-serial number of the drawback : ________________________
schedule under which the product
supplied is classified.
b) If All Industry rate of Drawback is : ________________________
available, Serial No. and rate of DBK.
7. Net weight of the product per unit, where : ________________________
unit is other than by weights.
8. Current F.O.R. Price of the product : ________________________
supplied
9. The C. Excise tariff. Chapter / Heading : ________________________
in which classified and rate of Central
Excise duty payable on the export
product.
10. State the mode of supplies : : ________________________
a) Whether under Central Excise Bond; : ________________________
b) After payment of duty under claim : ________________________
of rebate of Central Excise Duty.
c) Otherwise. : ________________________
(Strike out whichever is inapplicable)
11. Whether in respect of any of raw : ________________________
materials / components the benefits under
Rules 12A,12(1)(b) & 13(1)(b) or any
other Central Excise Rules is being
availed of, if so the details thereof in
respect of each input / raw material.
12. Whether in respect of any of the raw : ________________________
material / components MODVAT benefits under
Rule 57A of the Central Excise Rule is
being availed of? if so the details
thereof in respect of each input / raw
material. Whether any declaration has
been filed in terms of Rule 57(g) (1) of
Central Excise Rules for availing MODVAT
benefits under Rule 57A If so details
of inputs for which such benefit claimed
(Furnish details of credit in relevant
DBK-IIA / III A statements attached).
13. Whether benefit of Engineering Products : ________________________
Export (Replenishment of Iron & Steel
intermediate) Scheme or any other Scheme
for supply of raw materials at
international prices is being availed of
for any of the inputs for the manufacture
of the export product (if so furnish
details).
14. Whether the benefits of ITC PN-56/72 and : ________________________
78/72 are being availed of in respect of
any raw materials imported.
15. Whether any other benefit under any of : ________________________
the Customs and / or Central Excise
Notification is being availed of in
respect of the raw materials components
and other inputs used in the product
supplied.
16. Whether in respect of the imported : ________________________
material:
(a) the benefits of duty exemption : ________________________
Scheme is being availed of. If so the
details of the same (Viz:
DEEC / DEPB Number & date or application
number and date for DEEC / DEPB as the
case may be and the inputs for which DEEC
/ DEPB facility is being claimed. A
photocopy of the DEEC / DEPB to be
attached / forwarded). (b) manufacture
under bond procedure in terms of Section
65 of Customs Act, 1962 is being
followed; if so, the details thereof.
b) If yes, then did you declare this : ________________________
DBK claim in Special Imprest Licence
application also.
PART-B
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For fixation of Duty Drawback rates under Rule 6(1)(a) or Rule 7(1) of Drawback
Rules (Strike out whichever is not relevent).
17. (a) The drawback rate (or amount) : ________________________
expected (Enclose working sheet in
support thereof).
(b) In case the application is for : ________________________
fixation of special brand rate
under Rule 7(i) of the Drawback
Rules, is the rate indicated in
S.No.5 less than four-fifth of the
rate indicated in Col.16(a) above.
(c) In case the application is for : ________________________
fixing of Brand Rate under Rule 6
of the Drawback Rules,is the rate
worked out as at 16(a) above more
than 1% of FOR Value, if so the
percentage of Drawback Rate
Expected to FOR value.
18. (a) Is the FOR value with regard to each : ________________________
item in the Supply Invoice less than
the value of all imported materials
used in the manufacturing of such
goods ?
(b) If not, what is the percentage of value : _________________________
addition against each entry in the supply
Invoice.
19. Brief Process of manufacture, (Enclose :________________________
Catalogue / literature, etc. of the items
of Export.
PART-C
------
(For Refund of Terminal Excise Duty)
20. The Central Excise tariff Chapter / :________________________
heading in which classified & rate of
Central Excise Duty payable on the
product supplied.
21. Central Excise Invoice and corresponding :__________________________
RT - 12 showing amount of Terminal Excise
Duty paid or self certified Invoice
showing the amount of Terminal
Excise Duty paid
DECLARATION / UNDERTAKING
------------------------
1. I / We hereby declare that the particulars given above as well as in
accompanying Statements DBK I to III are correct to the best of my / our
knowledge and belief and that no separate application in respect of the same
goods has been submitted so far.
2. I / We full understand that any information furnished in the application if
proved incorrect or false will render me / us liable for any penal action or
other consequences as may be prescribed in law or otherwise warranted.
3. I / We undertake to abide by the provisions of the Foreign Trade(Development
and Regulation) Act, 1992, the Rules and Orders framed thereunder, the Export
and Import Policy and the Handbook of Procedures.
4. I / We also declare that I / We shall intimate any change (including receipt of
suo-motto refunds) in the particulars as mentioned in the proforma and
statements submitted within one month from the date of such change and I / We
agree to any consequential change in the Drawback Rates with effect from the
date of changed Drawback Rates are allowed and shall on demand by an Officer of
DGFT / D.C. repay the amounts received in excess.
5. I / we further declare that I / We shall immediately refund the amount of
drawback obtained by us in excess of any amount / rate which may be re-
determined by Government as a result of post varification.
6. I / We further declare that no export proceeds are outstanding beyond the
prescribed period as laid down by the RBI ,or such extended period for which
RBI permission has been obtained.
7. I hereby certify that I am authorised to verify and sign this declaration as
per Paragraph 3.8 of the Policy.
Signature of the Applicant : ____________
Name : ____________
Designation : ____________
Official Address : ____________
____________
Place : Tele.No.: ____________
Date : Residential Address : ____________
E.Mail address : ____________
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Documents to be enclosed with the application form:
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A. FOR REFUND OF TERMIAL EXCISE DUTY :
i) Application in Appendix 17
ii) Supply invoices certified by Project Authority and self certified.
In case of 100% EOUs / EPZ / STP / EHTP units, a complete AR-3A /
supply invoice certified by the bond officer is to be furnished.
iii) Payment certificate issued by the Project Authority as per Appendix
14B for supply to EOU / EPZ units the certificate to be given regarding
receipt of payment through normal banking channel. However, in respect
of supplies under paragraph 10.2 (d),(e),(f) and (g), wherever eligible
for refund of TED, if the applicant is not able to furnish payment
certificate, he may alternatively furnish the copies of the excise
invoices showing the receipt of the material by the Project Authority
duly countersigned by the authorised person for this purpose as given in
note (3) of Appendix - 14A, in lieu, of payment certificate.
(The Second Sentence of the para A(iii) has been amended vide Public Notice No.
11(RE-00)/1997-2002, Dt. 1-6-2000)
[Old
Howerver ,Payment certificate is not required in respect of supplies
under paragraph 10.2(d) (e) (f) (g). whenever eligible for refund of
TED. In such cases, the applicant shall furnish the copies of the excise
invoices showing the receipt of the material by the Project authority
duty countersigned by the authorised person for this prupose as given in
note (3) of Appendix-14A in lieu of payment certificate. ]
iv) Photocopy of complete A.R.O. / Back to BACK LC / DEEC (Special Imprest
Licence.)
v) Photocopy of the purchase order / L.O.I / contract with the (self
certified).
vi) Original input stage Invoices with corresponding RT-12 duly certified
by Excise authorities or self certified invoice showing the Terminal
Excise Duty paid.
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ADDITIONAL DOCUMENTS REQUIRED WHEREVER BRAND RATE OF DUTY DRAWBACK IS
BEING CLAIMED
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i) DBK I duly certified by a Chartered Engineer.
ii) DBK II, IIA, III & III-A, duly certified by a Chartered Accountant
alongwith non-availment of MODVAT Certificate from the jurisdictional
Excise Authorities.
iii)Photocopies of Bill of Entries alongwith relevant Import Invoices.
Note: In case of public sector undertaking, the DBK statements may be signed /
certified by the Head of Production and Head of Finance department.
STATEMENT - DBK-I
Description of the Export Product supplied...................Bill of
Materials* issued for manufacture of (No.of units of the export
product).
*(Bill of materials should consist of raw materials and components going
into the manufacture of export product supplied and the actual packing
materials used).
| Sl.No. | Name of Material /component | Quality | Technical Characteristics | Whether imported or indigenous | Unit | Gross Qty.reqd. |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| Wastage Qty. | Sale price of waste per unit of qty. | By product/coproduct | Ne wt. of the materia | Remarks |
| Irrcoverable | Recoverable | Qty. | sales value per unit |
| 8 | 9 | 10 | 11 | 12 | 13 | 14 |
Give convenient units by which goods are invoiced for export (e.g. per tonne, per
dozen / Pcs., per Sq. meter etc).
Notes:
1. The Units of quantity to be furnished in Col.6 should be given in such a manner
that it could be related to Statements II and III respectively.
2. Maintenance stores / materials such as lubricating oil, greases, fuel etc.
which are employed to run the machinery and plant should be excluded.
3. The data for packing materials should be for the same unit quantity for which
data for export product for raw materials and components have been given.
4. Only those raw materials / components etc. to be indicated for which proof of
payment of Customs / Central Excise duties is shown in DBK-II / III. Details of
such inputs need not be given where no benefit of duty paid is claimed because
of MODVAT or absence of proof of duty. Only a brief mention of such inputs
being used would be sufficient.
CERTIFICATE REQUIRED FOR DBK-I STATEMENT
1. On behalf of the applicant, I hereby certify that the materials as mentioned
above are actually required and being used for production of export product.
Station _____________ Signature _________________
(Name & Designation of the Chief
dated _____________ Executive / Production incharge
with seal.)
II. It is certified that (To be given by an independent Chartered Engineer):
a) The consumption of various materials shown in DBK-I has been examined by us
and these are actually required and being consumed in the factory of production for
manufacture of export product supplied as checked by us on verification of the
production process and relevent technical and related documents.
b) The imported materials above shown in DBK-I are being actually used in the
manufacture of the export product supplied and are not being substituted by
indigenous materials;
c) The wastage / co-product / by-product claimed are as per production process
in the factory. There is no suppression of co-product / by-products. The wastages
claimed in our views are reasonable and are comparable to the general norms for
the industry.Where wastages are considered high, an indication of the normal
wastage in the industry has been indicated by us, under "Remarks" column.
Signature__________________________
Name_______________________________
Designation________________________
Address____________________________
Place___________ Branch of Engg.
Date____________ in which qualified:_______________
Name & Address of the institution
under which Charted.Ref.No.and date
of membership.
STATEMENT - DBK - II
Direct import of materials / components made by the manufacturer and foreign materials
obtained locally by the manufacturer during the period commencing three months prior
to the date of supply / first supply upto the date of application, for manufacture
of ______________________ (Name of export product supplied).
| Sl.No | Description | Technical characteristics | S. No.DBK I Statement | B/E No.& Date under which imported | Name of the Customs House | Unit | Qty.imported originally | Assessable value |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
| | | | | | | | | |
| Heading no. in Customs Tariff Act. 1975 | Rate of duty | Country from where imported & name of supplier | Is assessment final | Basic duty + Additional customs duty paid | Name and address of the supplier in case the foreign material component obtained locally | Remarks |
| 10 | 11 | 12 | 13 | 14 | 15 | 16 |
| | | | | | | |
|
Notes:
1. If any of the materials mentioned above have also been procured from indigenous
origin,this must be specifically stated in remarks column and full details of
the procurement alongwith proof of payment of duty should be furnished in DBK-
III statemnt, even if it is claimed that they are not used in the products
exported.
2. Minor items which do not contribute to any significant proportion to the
expected drawback rates may be ignored, at the discretion of the applicant.
3. If the assessment against any B/E is not final the nature of dispute may be
clearly indicated supported by appropriate letter from concerened customs
authorities. Normally no DBK is admitted for provisionally assessed B/Es.
4. Refund application made against any B/E, with details must be indicated.
5. Stock position of the above materials / Components also to be given separately
(in linked statement II-A).
CERTIFICATE
............
Certified that the particulars mentioned in this statement are correct to the best of
my knowledge and belief and no claims for refund of duty in respect of any of the
above mentioned bills of entries (other than whose details are furnished) has been or
will be lodged with the customes Authorities.
Signature and Stamp of independent Signature _________________
Chartered Accountant/ Cost Accountant (Name & Designation of
Chief Executive/Production incharge
with seal.)
STATEMENT - DBK - IIA
Details of procurements relating to stock of imported materials as on commencement
*date (*the date three months prior to the date of supply / first supply required for
the manufacture of ____________________________(Name of export product supplied).
| Sl.No | Description | Technical characteristics | S. No.DBK I Statement | B/E No.& Date under which imported | Name of the Customs House | Unit | Qty.imported originally | Assessable value |
| 1 | 2 | 3 | 4 | 5 | 6 | 6A | 7 | 8 |
| | | | | | | | | |
| Heading no. in Customs Tariff Act. 1975 | Rate of duty | Country from where imported & name of supplier | Is assessment final | Basic duty + Additional customs duty paid | Name and address of the supplier in case the foreign material component obtained locally | Stock as on........ | Remarks |
| 9 | 10 | 11 | 12 | 13(13A) | 14 | 15 | 16 |
| | | | | | | | |
|
Note:-
1. In this statement furnish details of stock of all the imported inputs mentioned
in statements II which were in stock 3 months prior to the date of shipment /
first shipment of the export product and how these were imported / procured.
((Actual stock to be given under Col. 15, with procurement details in other
Columns).
2. If the assessment for any of the inputs in stock as shown is not final, the
nature and current status of dispute may be clearly indicated. (Normally no DBK
for provisionally assessed B/E are admitted).
3. Refund applications made if any for procurement shown in stock with details to
be indicated.
4. Photocopies of all Bills of Entries mentioned above must be enclosed.
CERTIFICATE
Certified that the particulars mentioned in this statement are correct to the best of
my knowledge and belief and no claims for refund of duty in respect of any of the
above mentioned bills of entries has been or will be lodged with the Customs
Authorities.
Signature and Stamp of independent
Signature
Chartered Accountant / Cost Accountant
STATEMENT - DBK - III
Materials / Components of Indian Origin obtained by the manufacturer during the period
commencing three months prior to the date of supply / first supply upto the date of
aapplication for the manufacture of ___________________ (Name of export product
supplied).
| Sl.No | Description | Technical characteristics | S. No.DBK I Statement | Unit | Qty.Purchased | Assessable value |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 |
| | | | | | | |
| Customs Tariff Heading no. | Effective Rate of duty paid | Amount of duty paid | Name and Address of supplier | Invoice No. and date | Is assessment on duty final | Remarks |
| 8 | 9 | 10 | 11 | 12 | 13(13A) | 14 |
| | | | | | | |
|
Notes:-
1. In this statement details of only those items which are chargeable to the
excise duty to be given for which proof of Central Excise duty can be
established by Invoices.
2. Materials / Components specified in Drawback II Statement if these are also of
indigenous origin and procured locally should be included in this statement,
whether dutiable or not. This is irrespective of the fact whether the said
materials / components are used for export production or not. Where the said
materials / components are claimed to be only for manufacture of goods for
local sales and not for exports, this should be specifically indicated in the
"Remarks" column, against the respective serial number of the said material /
component.
3. The particulars of Invoice numbers and date where the applicant is the
consignee should be furnished under col.11. Photocopies of all Invoices for inputs
which are subject to Central Excise Duties of 20% or higher and some
representative copies for other Invoices must be enclosed.
4. If the assessment which is not final or duty is paid under protest the extent
of dispute may please be clearly indicated ( copy of S V B Order to be
attached.
5. Refund applications made if any against any Invoice with Details, to be
indicated.
CERTIFICATE
Certified that the particulars mentioned in this statement are correct to the best of
my knowledge and belief and no claims for refund of duty in respect of any of the
above mentioned materials / components procured against Invoices / subsidiary
Invoices has been or will be lodged with the Central Excise Authorities.
Chartered Accountant / Cost Accountant Signature _________________
Signature and Stamp of independent (Name & Designation of the
Chief Executive / Production
incharge
with seal.)
STATEMENT - DBK - III(A)
Details of procurments relating to stocks of indignous materials as on commencement to
(the date three months prior to the date of supply / first supply)
| Sl.No | Description | Technical characteristics | S. No.DBK I Statement | Unit | Qty.Purchased | Assessable value |
C.Ex.Tariff Heading No. |
| 1 | 2 | 3 | 4 | 4A | 5 | 6 | 7 |
| | | | | | | | |
| Effective Rate of duty paid | Amount of duty paid | Name and Address of supplier | Invoice No. and date | Is assessment on duty final | Stock as on................ | Remarks |
| 8 | 9 | 10 | 11 | 12 | 13 | 14 |
| | | | | | | |
|
Notes:-
1. In this statement furnish details of stock of all the indigenous materials
mentioned in statements I & III which were in stock three months prior to date
of shipment / first shipment of the export product and how these were procured
(including Invoices Nos.etc.).
1A. In this statement details of only those items which are chargeable to the
Excise Duty may be given for which proof of payment of C.Excise duty can be
established.
2. The particular of Invoice number, date etc. should be furnished in Column 11.
3. If the assessment which is not final or duty is paid under protest the extent
of dispute may please be clearly indicated.
4. Refund applications made if any with details to be indicated.
CERTIFICATE
Certified that the particulars mentioned in this statement are correct to the best of
my knowledge and belief and no claims for refund of duty in respect of any of the
above mentioned materials / components has been or will be lodged with the Central
Excise Authorities.
Station: Signature and Stamp Signature ________
Date of independent / Chartered Accountant / Cost
Accountant
(Name & Designation of
Executive / Production
incharge
with seal)