FORM A-2
                          [Refer condition at S. No. 3 (II)(b)]

Authorisation for procurement of services by a SEZ Unit/Developer for authorised
operations under notification No.12/2013- Service Tax dated 1st July, 2013

A:    Details of SEZ Unit/Developer:
      1.      Name of the SEZ Unit/Developer:
      2.      Address of the SEZ Unit/Developer with telephone and email:
      3.      Permanent Account Number (PAN) of the SEZ Unit/Developer:
      4.      Import and Export Code Number:
      5.      Jurisdictional Central Excise/Service Tax Division:
      6.      Service Tax registration number / Service Tax Code/Central Excise
              registration number:






B: The details of specified services that the SEZ Unit/Developer is authorised to
procure in terms of declaration furnished by the SEZ Unit/Developer

Sl.No. Specified service(s) to be   Details of service provider(s) who provide(s) the
       received for the             specified service(s), for SEZ authorised
       authorised operation         operations
                                    Name and address      Service Tax
                                                          registration No.



(1)                      (2)        (3)                    (4)




(Signature and the stamp of the jurisdictional Deputy Commissioner of Central Excise
/Assistant Commissioner of Central Excise)

Phone No:
Fax No.: