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Form- A Quarterly return for production and removal of goods under area based exemption
August, 08th 2013
                                                     (See rule 12)
1.         Name and address of the assessee / manufacturer :
2.         PAN :
3.         Range ________Division________________Commissionerate________________
4.         Period of return : Quarter ending _______________________
5.         Details of the manufacture and removal of goods under                      Notification No. 49/2003-CE
                   th                                                                           th
dated the 10            June, 2003 or        Notification No. 50/2003-CE dated the 10                June, 2003 (Tick
whichever is applicable) :
8- Digit Description            Unit of   Quantity      Quantity and value of goods removed
Central of goods                quantity manufactured from factory
Excise                                                  Export              Sale within India         Other removals
Tariff                                                                                               not involving
Item No.                                                                                             sale such as
                                                                                                     transfer of
                                                                                                     goods to a
                                                                                                     depot or
                                                                                                     transfer to
                                                                                                     another factory,
                                                        Quantity Value Quantity          Value Quantity Value
                                                                     (Rs)                (Rs)                   (Rs)
     (1)            ( 2)           ( 3)       (4)          (5)        (6)      ( 7)        ( 8)         ( 9)       (10)

      6.         Please indicate if any raw material or inputs have been procured from or any
                 clearances mentioned in from Column (7) to (10) have been made to any related
                 person or another unit of the same manufacturer. If so, please furnish the following
                 information :
           (a)          Name and address of the related person/unit :
           (b)          PAN number of the related person/unit :
           (c)          Quantity of raw material/input received_____ and value thereof _______
           (d)          Quantity of goods cleared________ and value thereof __________
I hereby declare that the information given above is true, correct and complete in every respect.

                                                                     (Signature and name of the
                                                                     manufacturer or authorized


                                                                          Q    Q       Y    Y   Y      Y
Return of goods produced and manufactured by availing exemption
notification No.49/2003-CE / No.50/2003-CE for the quarter ending

                                                            D   D         M    M       Y    Y   Y      Y
Date of receipt

                                                                     (Name and signature of the
                                                                     competent Officer with official


1. In case, more than one item is manufactured, additional row may be inserted in the table,
wherever necessary.

2.          Wherever quantity codes appear, indicate relevant abbreviations as given below.

Quantities           Abbreviations             Quantities              Abbreviations
Centimetre(s)        cm                        Metre(s)                m
Cubic                Cm3                       Square                  m2
centimetre(s)                                  metre(s)
Cubic metre(s)       M3                        Millimetre(s)           Mm
Gram(s)              G                         Metric tonne            Mt
Kilogram             kg                        Number of pairs         Pa
Kilolitre            kl                        Quintal                 Q
Litre(s)             L                         Tonne(s)                T
Thousand in          Tu                        Number                  U

3.         8-Digit Central Excise Tariff Item number for each and every excisable good is available in
the Central Excise Tariff and same should be indicated without decimal point.

4.          In column numbers (5) to (10), the value means -

(1) If the goods are sold from the factory, the sale invoice value of the goods excluding all
(2) If the goods are exported from the factory, the export invoice value of the goods;
(3) In any other case of removal like transfer of goods to a depot or transfer to another
    factory, the value of the excisable goods may be taken as the value of such goods,
    excluding all taxes, sold by the manufacturer for delivery at any other time nearest to the
    time of the removal of goods being reported upon.

5.          For the purpose of filing this return, "related person" shall have the same meaning
assigned to it in clause (b) of sub-section (3) of section 4 of Central Excise Act, 1944."
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