Customs Forms
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BILL OF EXPORT OF GOODS UNDER CLAIM FOR DUTY DRAWBACK |
Original |
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Exporter |
Invoice No. & Date |
BE No. & Date |
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AR4/ AR4A No. & Date |
Import-Export Code No. |
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Q/ Cert No. & Date |
RBI Code No. |
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Consignee |
Export Trade Control |
If export under Deferred Credit [ ] Joint Ventures [ ] Rupee Credit [ ] Others [ ] RBI's Approval/Cir. No. & Date |
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Custom House LIC No. Agent
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| Lorry No./ Goods Train & Wagon No. | Originating From |
Type of Shipment Outright Sale [ ] Consignment Export [ ]
Others specify [ ] |
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| Land Cus. station | |||||||||||||||||||||
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Place of Delivery |
Country of Destination |
Nature of Contracts: CIF [ ] / CFR [ ]/FOB Others (specify) [ ] |
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Exchange Rate U / S 14 of CA |
Currency of Invoice |
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S. No. |
Marks & Nos. |
No. & Kind of Pkgs. Container Nos. |
Statistical code & Description of Goods
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Quantity |
Value FOB |
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Net Weight |
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Gross Weight |
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Total FOB Value in words |
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Analysis of Export Value |
Currency |
Amount |
Full export value OR where not ascertainable, the value which exporter expects to receive on the sale of goods.
Currency.............
Amount.............. |
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FOB value |
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Freight |
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Insurance Rate |
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Commission |
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Discount |
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Other |
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Deductions |
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Import Particulars of Bonded goods |
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Bill of Entry No. & Date |
Vessels Name and Rotation No. |
No. of Pkgs. |
Bond No. & Date |
Name of Bonded Warehouse |
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Declaration:
I/We declare that all particulars given herein are true and correct
I/We also attach the declaration (s) under clause No. (s).................
Public Notice No......................... dated........................ Signature of Exporter |
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BILL OF EXPORT OF GOODS UNDER CLAIM FOR DUTY DRAWBACK Export Promotion Copy |
Original |
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Document Submitted [ ] 1. Invoice [ ] 2. Packing List [ ] 3. G R Form [ ] 4. AR-4 / AR-4A Form [ ] 5. ETC Licence [ ] 6. Indent [ ] 7. Acceptance of Contract [ ] 8. Letter of Credit 9. QC certificate 10. Port trust document 11. Any other (specify) |
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BILL OF EXPORT OF GOODS UNDER CLAIM FOR DUTY DRAWBACK |
Duplicate |
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I/We claim drawback of Rs. .... Under Sec-74/75 of Customs Act 1962 and Customs and Central Excise Duty Drawback Rules, 1971. I/We certify that the goods are new/used for .... I/We certify that I/We have complied with the conditions subject to which Drawback rates are applicable.
1. Name and address of Bank
. 2. Account No 3. DBK Ledger No |
Document Submitted
1. Invoice [ ] 2. Packing List [ ] 3. G R Form [ ] 4. AR-4 / AR-4A Form [ ] 5. ETC Licence [ ] 6. Indent [ ] 7. Acceptance of Contract [ ] 8. Letter of Credit 9. QC certificate 10. Port trust document 11. Any other (specify) |
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Item No. in S/B |
S. No. & Sub S. No. of DBK |
Qty/Wt. On which DBK |
Value on which DBK |
Rate of DBK |
Amount of DBK |
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Schedule |
Claimed |
Claimed | Excise | Customs | Excise | Customs | Total | ||
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Total amount in words Rupees ......... .. Signature of Exporter / CHA |
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Let export
Signature |
Allowed for shipment
Signature |
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Carrier's Name & Lorry No. / Goods Train & Wagon No. may be altered after check with original Fee Rs. Entry for Fresh one may be granted to . For the portion or not shipped Received Handed over to C. W. A. / Party Signature Asst. Commissioner Cashier |
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Contents received on Board |
Date of shipment |
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Date Mater of Vessel |
Customs officer |
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Examination order and report |
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BILL OF EXPORT OF GOODS UNDER CLAIM FOR DUTY DRAWBACK Export Promotion Copy |
Triplicate |
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Exporter |
Invoice No. & Date |
SB No. & Date |
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AR4/ AR4A No. & Date |
Import-Export Code No. |
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Q/ Cert No. & Date |
RBI Code No. |
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Consignee |
Export Trade Control |
If export under Deferred Credit [ ] Joint Ventures [ ] Rupee Credit [ ] Others [ ] RBI's Approval/Cir. No. & Date |
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Custom House LIC No. Agent
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| Lorry No./ Goods Train & Wagon No. | Originating From |
Type of Shipment Outright Sale [ ] Consignment Export [ ]
Others specify [ ] |
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| Land Cus. station | |||||||||||||||||||||
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Place of Delivery |
Country of Destination |
Nature of Contracts: CIF [ ] / CFR [ ]/FOB Others (specify) [ ] |
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Exchange Rate U / S 14 of CA |
Currency of Invoice |
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S. No. |
Marks & Nos. |
No. & Kind of Pkgs. Container Nos. |
Statistical code & Description of Goods
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Quantity |
Value FOB |
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Net Weight |
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Gross Weight |
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Total FOB Value in words |
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Analysis of Export Value |
Currency |
Amount |
Full export value OR where not ascertainable, the value which exporter expects to receive on the sale of goods.
Currency.............
Amount.............. |
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FOB value |
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Freight |
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Insurance Rate |
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Commission |
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Discount |
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Other |
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Deductions |
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Import Particulars of Bonded goods |
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Bill of Entry No. & Date |
Vessels Name and Rotation No. |
No. of Pkgs. |
Bond No. & Date |
Name of Bonded Warehouse |
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Declaration:
I/We declare that all particulars given herein are true and correct
I/We also attach the declaration (s) under clause No. (s).................
Public Notice No......................... dated........................ Signature of Exporter |
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BILL OF EXPORT OF GOODS UNDER CLAIM FOR DUTY DRAWBACK Export Promotion Copy |
Triplicate |
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I/We claim drawback of Rs. .... Under Sec-74/75 of Customs Act 1962 and Customs and Central Excise Duty Drawback Rules, 1971. I/We certify that the goods are new/used for .... I/We certify that I/We have complied with the conditions subject to which Drawback rates are applicable. 1. Name and address of Bank . 2. Account No 3. DBK Ledger No |
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Item No. in S/B |
S. No. & Sub S. No. of DBK |
Qty/Wt. On which DBK |
Value on which DBK |
Rate of DBK |
Amount of DBK |
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Schedule |
Claimed |
Claimed | Excise | Customs | Excise | Customs | Total | ||||
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Total amount in words Rupees ......... .. Signature of Exporter / CHA |
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For department officer
Verified that the amount of DBK as claimed above is admissible subject to description found correct on the basis of physical examination / test etc. Signature of A.C. & Stamp |
Calculation Checked.
Comptist |
Pre-receipt form
Received the sum of Rs as drawback.
Revenue Stamp Signature of Exporter / CHA |
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Let export
Signature of Officer of Customs |
Allowed for shipment
Signature of Officer of Customs |
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| Claim Pre-audited for Sanction | Claim passed for Rs | ||||||||||
| Inspector (Audit) | Supdt. A/C | ||||||||||
| Claim Registration No .. issued Cheque No .. Dated | |||||||||||
| For Rs .. (Rupees ) | |||||||||||
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Dealing Clerk |
Officer |
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| Examination Order and Report | |||||||||||
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BILL OF EXPORT OF GOODS UNDER CLAIM FOR DUTY DRAWBACK |
Quadruplicate |
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Exporter |
Invoice No. & Date |
SB No. & Date |
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AR4/ AR4A No. & Date |
Import-Export Code No. |
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Q/ Cert No. & Date |
RBI Code No. |
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Consignee |
Export Trade Control |
If export under Deferred Credit [ ] Joint Ventures [ ] Rupee Credit [ ] Others [ ] RBI's Approval/Cir. No. & Date |
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|
Custom House LIC No. Agent
|
|||||||||||||||||||||
| Lorry No./ Goods Train & Wagon No. | Originating From |
Type of Shipment Outright Sale [ ] Consignment Export [ ]
Others specify [ ] |
|||||||||||||||||||
| Land Cus. station | |||||||||||||||||||||
|
Place of Delivery |
Country of Destination |
Nature of Contracts: CIF [ ] / CFR [ ]/FOB Others (specify) [ ] |
|||||||||||||||||||
|
Exchange Rate U / S 14 of CA |
Currency of Invoice |
||||||||||||||||||||
|
S. No. |
Marks & Nos. |
No. & Kind of Pkgs. Container Nos. |
Statistical code & Description of Goods
|
Quantity |
Value FOB |
||||||||||||||||
|
Net Weight |
|||||||||||||||||||||
|
Gross Weight |
|||||||||||||||||||||
|
Total FOB Value in words |
|||||||||||||||||||||
|
Analysis of Export Value |
Currency |
Amount |
Full export value OR where not ascertainable, the value which exporter expects to receive on the sale of goods.
Currency.............
Amount.............. |
||||||||||||||||||
|
FOB value |
|
|
|||||||||||||||||||
|
Freight |
|
|
|||||||||||||||||||
|
Insurance Rate |
|
|
|||||||||||||||||||
|
Commission |
|
|
|||||||||||||||||||
|
Discount |
|
|
|||||||||||||||||||
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Other |
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|
|||||||||||||||||||
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Deductions |
|
|
|||||||||||||||||||
|
Import Particulars of Bonded goods |
|||||||||||||||||||||
|
Bill of Entry No. & Date |
Vessels Name and Rotation No. |
No. of Pkgs. |
Bond No. & Date |
Name of Bonded Warehouse |
|||||||||||||||||
|
|
|
|
|
|
|||||||||||||||||
|
Declaration:
I/We declare that all particulars given herein are true and correct
I/We also attach the declaration (s) under clause No. (s).................
Public Notice No......................... dated........................ Signature of Exporter |
|||||||||||||||||||||
|
BILL OF EXPORT OF GOODS UNDER CLAIM FOR DUTY DRAWBACK Export Promotion Copy |
Quadruplicate |
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Verified Mates Receipt No issued by . ............... For Cases/Bales/Packages/Containers .. ........... Shipped per ...................................... Which sailed on ........................ From .....................
Under Preventive Supervision
Signature of Officer of Customs |
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