Customs Forms - Form 110 - Claim of drawback under rule 11

Customs Forms

Form for claim of drawback

ANNEXURE-I

FORM D

Original

Duplicate

Triplicate

Quadruplicate

Ref. Dbk.

Invoice No.
Dated :

Particulars of goods to be exported by parcel post under claim for drawback

FORM NO.

The Assistant Commissioner of Customs

(Drawback) Foreign Post Office,

We,............................................................................................................... Propose to export the undermentioned consignment.

Name and Address of the Consignee.......................................................................................................................

S.No.	Date of Parcels	Gross Weight	Marks/ No. on Pcs.	Qty.	FOB Value	Rate of new DBK	Weight	Amount Rs. P.
1	2	3	4	5	6	7	8	9

1.	Certified that the goods were not taken into use after the manufacture.
2.	Certified that no separate claim for rebate of duty has been made or will be made to the Central Excise, Authorities under rules 12 and rule 191B as in force immediately before 1st October, 1994 or under rule 13 of Central Excise Rules, 1944 and that the Customs and Central Excise duty has been paid on the raw material used in the manufacture of the goods.
	We hereby declare that the declaration made herein is true and correct.

Office seal of

Manufacturer/Exporter

Signature

Name............................

Designation....................

Dated :

Place :