I apply for the permission to clear the gold/silver, as per the particulars given above, from the customs bonded warehouse subject to the provisions of the Customs Act, 1962 (52 of 1962)

Place :

(Signature of the passenger with date)

(PART-B)

(To be completed by the Air Customs Officer)

7.

Customs Tariff Heading No.

8.

Rate of Duty

Exemption Notification No.

9.

Duty assessed

(a) in words :

(b) in figures :

                            Verified the particulars from the passport of the passenger. The passenger is eligible to clear the gold/silver from customs bonded warehouse in terms of Notfn. No.................. Dated....................

Date :

(Signature of the A.C.O.

(Counter Signature by ACS)

(PART-C)

(To be completed by the Bank Counter receiving customs duty)

10.

Duty recovered in convertible foreign currency equivalent to Indian Rupee

(a) In words :

(b) In figures :

Date :

(Signature & Seal of the Bank Officer)

(PART - D)

(To be completed by the Customs Officer at the airport)

Passed out of customs charge

Date :

(Signature of Air Customs Superintendent)

(PART - E)

(To be completed by the warehouse keeper giving delivery)

11.

Description

:

12.

Marks and Nos.

:

13.

Quantity Delivered

:

14.

Bond No.

:

Place :

Date :

(Signature of warehouse keeper with seal)

Received the gold/silver as per particulars mentioned above

(Signature of the passenger taking delivery with date)

(PART-F)

(For Audit)

15.

Amount of short recovery

:

16.

Amount of excess recovery

:

Date:

(Signature of the Audit Officer)