APPENDIX - 4 I

(Please see Para 4.18 to 4.21 of HBP)

Register for accounting of consumption and stocks of duty free imported or domestically procured raw materials, components etc. allowed under advance authorisation for pharmaceutical product manufactured through Non Infringing (NI) process.

Inputs allowed in the authorisation

Product(s) exported under the authorisation

Bal anc e inp uts, if any (4 — 8)

In case of balance inputs as in column 9

Rem arks

Sl

No.

Authorisatio n No (s) with date

Nam e of the Input

s

Quant ity

Name of the Produ ct

Quan' ty

Inputs Actually consumed for the exported product**

Additio nal exports effecte d in proport on to excess inputs

Input quantity reduced proportion ate-ly in the authorisati on*

Custom s duty paid alongwit h interest

Inputs

Quantity (Includin g actual wastage incurred )

1

2

3

4

5

6

7

8

9

10

11

12

13

*App

icable only in case either partial import or “NI

J’ import

has been effected.

** In case of post export replenishment, details of inputs used (whether duty paid or not) in the exported product has to be furnished.

We declare that the aforesaid particulars are correct.

Place:

Date:


Signature of the authorisation holder Name in block letters: ___________.

Full official address: ____________

Full Residential address: _________

Official Seal / Stamp


Telephone No.: ________________

E-mail: ______________________

Note:

FORMAT OF CENTRAL EXCISE CERTIFICATE

I hereby confirm that I have examined the production details and the records of M/s __________(Name of the

authorisation holder) and verified the details furnished in Appendix 4-I format. I hereby certify the following details of consumption of inputs for the pharmaceutical product, manufactured through Non Infringing (NI) process, against their advance authorization No. -------------- dated -----------.

Date:                                                          Name of the Central Excise official:

Place:                                                          Designation:

Office seal/Stamp:                                              Telephone No. (O):

E-mail address (if any):

Postal Address:

Note: