ANF-7A

1.	IEC No	Branch Code:
2.	Applicant details: i. Name of the firm/company ii. Full address iii. Contact Number iv. E-mail address
3.	Bank’s details: i. Name of the Bank ii. Address of the Bank iii. IFSC code iv. Nature of account(SA/CA) v. A/c Number vi. Telephone / Fax No.
4.	(a) Excise Authority details: i. Excise Registration No ii. Address of the jurisdictional Excise/GST Authority iii. Contact details of Excise Authority iv. Amount of excise duty paid during last year v. Product registered for manufacturing activities
4.	(b) Jurisdictional Customs Authority details: i. Address of the jurisdictional Customs Authority ii. Contact details of Jurisdictional Customs Authority iii. Amount duty paid during last year iv. Product registered for manufacturing activities
5.	Application for: i. Refund of Terminal Excise duty ii. Refund of Duty Drawback as per AIR iii. Fixation of brand rate for duty draw back
6.	Application is made by: (i) Supplier of goods (ii) Recipient of goods
7.	Supply details: i. Description of goods ii. Category of supplies under Para 7.02 of FTP

Sl. No	Inv. No.	Date of		Description of item(s) of supply	Quantity	Quantum of TED	Late cut, if any	Net claim
		Supply	Payment

Sl.No	Invoice No.	Date of		Description of item(s)of supply	Tariff No	FOR value	Net quantity of supplies	Draw back Rate
Sl.No	Invoice No.	Supply	Payment

10.	If supply towards discharge of export obligation to Advance Authorisation Holder against Invalidation letter and drawback is claimed on inputs either imported or procured locally on payment of basic custom duty: Whether, in the application for Advance Authorisation for intermediate supply, it was declared that such inputs to be procured locally /imported on payment of basic custom duty?	Yes/No
11.	If answer to Col. No 10 is yes, Advance Authorization no. & date and File. no. under which it was issued.
12.	Whether claim is made within the prescribed time
13.	If not, rate of late cut as per Para 9.02 of HBP
14.	If claim for refund of TED is made by supplier: Whether CENVAT credit has been availed by recipient?
15.	If claim for refund of TED is made by recipient: Whether CENVAT credit has been availed by him?
16.	If claim for duty drawback is made by supplier: Whether CENVAT credit has been availed by him on excisable inputs
17.	If claim for duty drawback is made by recipient of goods: Whether CENVAT credit has been availed by supplier of goods on excisable inputs?
18.	In case of claim made against supply under Para-7.02(a) & (c) whether authorization number and date figure in the supply invoices/ARE.
19.	If the application is for fixation of brand rate: Drawback rate under AIR not available AIR is less than 4/5 of actual duty paid. (i) Claim is made for basic customs duty.
20	If answer to Col. 19 is yes, Whether: 1. Inputs/components were imported directly : 2. Imported inputs/component used from stock/ out sourced locally

21. DBK-I Statement

SL No	Name of the	Quality/ Technical	Whether	Unit	Gross	Wastage Quantity
	materials/ Components	Characteristics	imported/ indigenous		Quantity required	Irrecoverable	Recoverable
1	2	3	4	5	6	7	8

Sale Price of waste per u nit of Qty	By Product/ co-product		Net wt. of the material	Remarks
	Qty.	Sale value per unit
9	10	11	12	13

22. Statement of inputs/components used, either imported or imported materials procured locally **

S.No	Description	Technical characteristics	S.No. in DBK-I statement	B/E /Invoice No & date under which imported/procured	Name of the Customs House/Excise Authority	Unit	Qty. imported/procured locally	Assessable value
1	2	3	4	5	6	7	8	9

Heading No. in Customs Tariff Act, 1975	Country from which imported / name of supplier	Name and full address of the supplier in case the foreign material/ Components obtained locally	Rate of Duty	Is assessment final	Total amount of duty paid (basic custom duty)	Remarks
10	11	12	13	14	15	16

** Only inputs which were imported/ procured and consumed during the period commencing 90 days prior to the date of supply(s) shall only be taken into account for such claim.

A separate work sheet as per DBK form II, and II(A) and certificates attached thereto duly certified by Chief Executive/production in-charge shall be submitted, as given in the APPENDIX-7E

23. Check List of documents to be attached duly scanned or submitted in the physical form at counter:

(1)(a)Copy of Invoices or a statement of invoices duly signed by the units receiving the excisable goods and attested by Excise/GST Authorities, as per the procedure prescribed by CBEC in their circular 15/2008-Cus. dated 26.9.2008. To facilitate attestation by Excise/GST Authorities, intimation regarding receipt of goods should be given to the said authorities within 48 hours of receipt of goods. Corresponding ER-1/ER-3 or a monthly statement confirming duty payment attested by Excise/GST Authorities or Invoices/statement of Invoices certified by Jurisdictional Excise/GST Authority of recipient.
(b) In case of supply of non-excisable goods, copy of Tax invoices as prescribed under GST Rules or a statement of invoices duly signed by the units receiving the goods and attested by Jurisdictional Customs Authorities, as per the procedure prescribed by CBEC in their circular 15/2008-Cus. dated 26.9.2008. To facilitate attestation by Jurisdictional Customs Authorities, intimation regarding receipt of goods should be given to the said authorities within 48 hours of receipt of goods.

(2) In case supply of goods to EOU/EHTPI STPI BTP, procedure prescribed in Circular No-14/14/2017-GST dated 6th November, 2017 issued by GST Policy Wing, Central Board of Indirect Taxes and Customs, Department of Revenue shall be followed, Accordingly, copy of Form A along with copy of Tax Invoice duly endorsed by recipient shall be considered as proof of deemed export supplies,

(4) Proof of payment through e-BRC/Bank Certificate of Exports and Realization as per APPENDIX-2U or Payment Certificate issued by Project Authority in APPENDIX-7D in original, as the case may be.

(5) PAC issued by the Project Authority in original as per APPENDIX-7C or File No. where the original has been submitted.

(6) Copy of contract if supplies were to Project Authority or supplier’s copy of original ARO or recipient’s copy of original Invalidation Letter (if supply against ARO/Invalidation Letter issued against AA /DFIA/EPCG, as the case may be).

(7) Non-availment of CENVAT credit certificate as per ANNEXURE-I, by the recipient of finished goods (in case claim for TED).

(8) A certificate regarding non availment of CENVAT credit on inputs used in the resultant product by the supplier of goods as per ANNEXURE-II (in case claim for drawback).

(9) Declaration/disclaimer certificate from supplier, in case claim is filed by recipient of goods and from recipient of goods, if claim is filed by supplier of goods, as per ANNEXURE-III

(10) Statement of supplies for Fixation of Drawback Rate as per APPENDIX-7E.

1. I/We hereby declare that the particulars and the statements made in this application are true and correct to the best of my /our knowledge and belief and nothing has been concealed or held there from. If found incorrect or false, it will render me / us liable for any penal action or other consequences as may be prescribed in law or otherwise warranted.
2. I/We undertake to abide by the provisions of F.T. (D&R) Act, the Rules and Orders framed there under, the FTP, HBP, SION and the ITC(HS) Classification of Export & Import Items.
3. I/we further declare that the claim made by me/us is not a matter of right and I/we shall immediately refund the amount of TED/drawback obtained by us in excess of any amount/rate which may be re-determined by concerned RA / DGFT/Government as a result of post verification/Audit objection or otherwise.
4. None of the Proprietor/Partners(s)/Director(s)/Karta/Trustee of the firm/company has come under the adverse notice of DGFT or is in the caution list of RBI.
5. None of the Proprietor/Partners(s)/Director(s)/Karta/Trustee of the firm/company, as the case may be, is/are a Proprietor/Partner(s)/Director(s)/Karta/Trustee in any other firm/Company which has come under the adverse notice of DGFT or is in the caution list of RBI, to the bestof my knowledge.
6.  I / We hereby declare that no export proceeds are outstanding beyond the prescribed period as laid down by RBI or such extended period for which AD/RBI permission has been obtained.
7.    I/we further declare that the goods supplied are excisable goods but no CENVAT credit is availed/ available to the recipient of goods. (In case of items covered under schedule 4 of the central excise Act 1944).
8.   I/we further declare that no CENVAT credit facility has been availed on inputs for which drawback claim is made.
9.   I hereby certify that I am authorised to verify and sign this declaration as per Paragraph 11.06 of the FTP.

Signature of the Applicant
Name
Designation
Official Address
Telephone/Mobile No
Residential Address
Email Address
Place
Date

It is certified that no CENVAT credit under the Excise/GST Rules has been availed by us, nor will be availed in future, on supply of these items as per the application.

Signature (Authorized Signatory):
Full Name:
Designation:
Name of the company:
Telephone Number:
E-mail Address:
Fax No:

1. I, (Name & Designation) …..on behalf of M/s. ….. (Name and address of the supplier) hereby certify that we have supplied the following goods to M/s….. (Name and address of the recipient):

2. We are the manufacturer exporters/suppliers and are registered/not registered with Excise/GST Authority and have not availed and will not avail CENVAT credit facility in respect of duty paid on inputs/components and/or tax paid on input services, in aforesaid supplies. We have also not availed and will not avail rebate on the duty paid on inputs/components used in aforesaid supplies and/or tax paid on input services.
3. We also certify that we have not been issued any Advance Authorization/Duty Free Import Authorization in respect of the aforesaid supply of goods and have not availed any benefit thereon.
4. The complete address of the Jurisdictional Assistant/Deputy Commissioner of the Excise/GST Division is given as follows:

Yours faithfully,
Signature (Authorized Signatory)
Full Name
Designation
Name of the Company
Telephone Number
Address
Fax No.

Note: Declaration is to be given on letter head of the supplier. The Declaration furnished by the supplier to Office of the Development Commissioner or RA of DGFT should be in duplicate with complete address of the Jurisdictional Assistant/Deputy Commissioner of the Excise/GST Division. The Development Commissioner/RA of DGFT would forward the second copy of this Declaration, duly stamped, to the addressed Assistant /Deputy Commissioner of the Excise/GST Division for cross verification.

We hereby declare that we have neither drawn nor will draw any benefit of deemed export on supply of goods as declared/to be declared in the application for claim of deemed export benefits and we have no objection if M/s…… (Name and address of the recipient/supplier, as the case may be) draws the deemed export benefits on such supply of goods as mentioned in the application.

(Either party will have to give disclaimer in favour of other for not claiming benefits of deemed export against supply of goods as declared in the Application for claim. The disclaimer is to be submitted on the letter head of the firm/company)

Yours faithfully,
Signature (Authorized Signatory)
Full Name
Designation
Name of the company
Telephone Number
E-mail
Address
Fax No

FORMAT OF CERTIFICATE TO BE ISSUED BY PUBLIC SECTOR OIL COMPANIES CERTIFYING AMOUNT OF TED PAID BY EOU / PROJECT ON PURCHASE OF HSD FROM THEIR DEPOTS:

I _________ (name of authorized signatory of PSU Oil Company) hereby declare that we (name of the Company) have supplies HSD to M/s. __________(Name of EOU/Project) from our depot at-------- __________as per details given below.

Description	Invoice No.	Invoice Date	Quantity	Value	Total Duty paid (with breakup of components)

We hereby certify that we are not claiming any deemed export benefits on the above supplies and we do not have any objection if _______ (Name of EOU/Project) claims deemed export benefits.

Value Cap(if any	Amount of DBK	Late cut, if any	Net payable amount