Customs Forms
STATEMENT - DBK- III
Materials/Components of Indian Origin obtained by the manufacturer during the period commencing three months prior to the date of shipment upto the date of application for manufacture of ______________ (Name of export product).
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Sl. No. |
Description |
Technical Characteristics |
S.No. in DBK-I Statement |
Unit |
Qty. Purchased |
Assessable Value |
C. Ex. Tariff Heading No. |
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
|
Effective rate of duty paid |
Amount of duty paid |
Name & Address of supplier |
G.P. No. & date |
Is assessment of duty final ? |
Remarks |
|
9 |
10 |
11 |
12 |
13 |
14 |
| Notes : | 1. | In this statement details of only those items which are chargeable to the excise duty to be given for which proof of C. Excise duty can be established by Gate Passes. |
| 2. | Materials/components specified in Drawback-II Statement if these are also of indigenous origin and procured locally should be included in this statement, whether dutiable or not. This is irrespective of the fact whether the said materials/components are used for export production or not. Where the said materials/components are claimed to be only for manufacture of goods for local sales and not for exports, this should be specifically indicated in the remarks column, against the respective serial No. of the said material/component. | |
| 3. | The particulars of gate pass numbers and date where the applicant is the consignee should be furnished under Col. 11. Photo copies of all Gate Passes for inputs which are subject to Central Excise Duties of 20% or higher and some representative copies for other Gate Passes must be enclosed. | |
| 4. | If the assessment which is not final or duty paid under protest the extent of dispute may please be clearly indicated. | |
| 5. | Refund applications made if any against any Gate Pass with details, to be indicated. |
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CERTIFICATE |
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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 materials/components procured against Gate Passes/subsidiary Gate Passes has been or will be lodged with the Central excise Authorities. |
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Signature of the Power of Attorney Holder of Authorised Agent. |
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Signature and Stamp of independent Chartered Accountant/Cost Accountant |