Sl.

No.

Description

Technical

characteristics

S.No. in DBK-I

Statement

B/E No.

and date

under which imported

Name of

Customs house

Unit

Qty. imported

Assessable value

Heading

No. in Customs Tariff Act, 1975

1

2

3

4

5

6

6A

7

8

9

Rate of duty

Country from

where imported & name of supplier

Is assessment final ?

Amount of duty paid

Name & full address of the supplier in case the foreign materials/components obtained locally

Remarks

10

11

12

13

14

15

Note :

1.

If any of the materials mentioned above have also been procured from indigenous origin, this must be specifically stated in remarks column and full details of the procurement alongwith proof of payment of duty should be furnished in DBX-III statement, even if it is claimed that they are not used in the products exported.

2.

Minor items which do not contribute to any significant proportion to the expected drawback rates may be ignored, at the discretion of the applicant.

3.

If the assessment against any B/E is not final the nature of dispute may be clearly indicated supported by appropriate letter from concerned customs authorities. Normally no DBK is admitted for provisionally assessed B/Es.

4.

Refund application made against any B/E, with details must be indicated.

5.

Stock position of the above materials/components also to be given separately (ink linked Statement II-A).

CERTIFICATE

Certified that the particulars mentioned in this statement are correct to the best of my knowledge and belief and no claims for refund of duty in respect of any of the above mentioned bills of entries (other than whose details are furnished) has been or will be lodged with the Customs Authorities.