AI OCR 
TaxTMI 
TaxTMI 
TaxTMI 
APPLICATION FOR CLAIM OF TED REFUND / DUTY DRAWBACK / BRAND RATE FIXATION
X X X X Extracts X X X X
X X X X Extracts X X X X
....gistered 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 * If application is for refund on TED S. No Invoice No Date of Supply Date of payment Description of item(s) of supply Quantity Quantum of Refund of TED Late cut (if any) Net Claim EBRC/Payment Certificate No EBRC/ Payment certificate date Realized value (Provision to add multiple invoices) * If the application is for drawback as per AIR under drawback schedule: S. No Invoice No Date of Supply Date of payment Description of item(s) of supply Tariff No ....
X X X X Extracts X X X X
X X X X Extracts X X X X
....e AIR Rate as per Drawback schedule AIR amount FOB/ FOR value Total Custom Duty incidence claimed on inputs Qty of supply EBRC No/Payment certificate details EBRC Value/Payment certificate Late cut (if any) Final amount of Duty drawback claimed on inputs Remarks 22. Statement of inputs/components used, either imported or imported materials procured locally (applicable for brand rate fixation only) S. No Desc-ription Technical charact-eristics S. No of product supplied as per 21 above S.No. in DBK-I statement S.No in DBK II/ DBK II A statement as applicable Bill of entry and date under which item is imported If imported item is procured locally corresponding invoice details to be provided Name of Customs House ITC H....
X X X X Extracts X X X X
X X X X Extracts X X X X
.... the original has been submitted. 5. Copy of contract if supplies were to Project Authority or copy of digitally signed ARO or Invalidation Letter as the case may be (if supply against ARO/Invalidation Letter issued against AA /DFIA/EPCG, as the case may be). 6. Non-availment of CENVAT credit certificate as per ANNEXURE-I, by the recipient of finished goods (in case claim is for TED). 7. A certificate by the supplier of goods as per ANNEXURE-II (in case claim is for drawback). 8. 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 9. Statement of supplies for Fixation of Drawback Rate as per APPENDIX-7E. DECLARATION / UNDERTAKING 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 undertak....
X X X X Extracts X X X X
X X X X Extracts X X X X
....we have supplied the following goods to M/s (Name and address of the recipient): S. No. Inv. No. & date Description of goods Unit Qty. Value 2. 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. 3. 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 co....
X X X X Extracts X X X X
X X X X Extracts X X X X
....upplier's copy of original ARO/ Invalidation Letter (if supply against ARO/Invalidation Letter issued against AA/DFIA/EPCG)." 3. Substituted vide PUBLIC NOTICE No. 37/2015-2020 dated 04-09-2018 before it was read as "ANF-7A APPLICATION FOR CLAIM OF TED REFUND / DUTY DRAWBACK / BRAND RATE FIXATION (Please tick whichever is applicable) (Application shall be filed online once the software is ready) 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. Excise Authority details: (i) Excise Registration No (ii) Address of the jurisdictional Central Excise Authority (iii) Contact details of Excise Authority (iv) Amount of excise duty paid during last yea....
X X X X Extracts X X X X
X X X X Extracts X X X X
....bsp; 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 17. If claim for duty drawback is made by recipient of goods: Whether CENVAT credit has been availed by supplier of goods? 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: (i) Drawback rate under AIR not available (ii) AIR is less than 4/5 of actual duty paid. (iii) 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: 3. Indian origin inputs/components procured locally: 4. ....
X X X X Extracts X X X X
X X X X Extracts X X X X
....rs of receipt of goods. Corresponding ER-1/ER-3 or a monthly statement confirming duty payment attested by excise Authorities or Invoices/statement of Invoices certified by Jurisdictional Central Excise Authority of recipient. (2) In case supply of goods to EOU, ARE-3 duly certified by the recipient and their jurisdictional Central Excise Authority. (3) Self certified copy of B/Es (4) Proof of payment through e-BRC 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) 2[Copy of contract if supplies were made 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/EPCH, 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 ....
X X X X Extracts X X X X
X X X X Extracts X X X X
.... TERMINAL EXCISE DUTY (TED) It is certified that no CENVAT credit under the Central Excise 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: Note: To be given on the letter head of the recipient of goods. ANNEXURE-II DECLARATION FOR CLAIMING DEEMED EXPORT DRAWBACK 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): S. No. Inv. No. & date Description of goods Unit Qty. Value 2. We are the manufacturer exporters/suppliers and are registered/not registered with Central Excise 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 ....
X X X X Extracts X X X X
X X X X Extracts X X X X
.... have any objection if _______(Name of EOU/Project) claims deemed export benefits. Authorized Signatory (With full name and Designation)" 4. Substituted vide PUBLIC NOTICE No. 18/2015-2020 dated 23-09-2020 before it was read as "3[ANF-7A APPLICATION FOR CLAIM OF TED REFUND / DUTY DRAWBACK / BRAND RATE FIXATION (Please tick whichever is applicable) (Application shall be filed online once the software is ready) 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 Central Excise Authority (iii) Contact details of Excise Authority (iv) Amount of excise duty paid during last year ....
X X X X Extracts X X X X
X X X X Extracts X X X X
....2(a) & (c) whether authorization number and date figure in the supply invoices/ARE 19. If the application is for fixation of brand rate: (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 materials/ Components Quality/ Technical Characteristics Whether imported/ indigenous Unit Gross Quantity required Wastage Quantity Irrecoverable Recoverable 1 2 3 4 5 6 7 8 Sale Price of waste per unit 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 ** ....
X X X X Extracts X X X X
X X X X Extracts X X X X
....ued by GST Policy Wing, Central Board of Excise 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, (3) Self certified copy of B/Es (4) Proof of payment through e-BRC/Bank Certificate of Exports and Realisation 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) Deleted (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-II. (10) Statement of supplies for....
X X X X Extracts X X X X
X X X X Extracts X X X X
.... Fax No: Note: To be given on the letter head of the recipient of goods. ANNEXURE-II Deleted ANNEXURE-III DISCLAIMER CERTIFICATE FOR NOT CLAIMING DEEMED EXPORT BENEFITS 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 ANNEXURE-IV 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 (....
X X X X Extracts X X X X
X X X X Extracts X X X X
....nbsp; (Provision to be made to add multiple invoices) 9. If the application is for drawback as per AIR under drawback schedule: Sl. No. Invoice No. Date of Description of item(s)of supply Tariff No. FOR value Net quantity of supplies Draw back Rate Supply Payment Value Cap (if any) Amount of DBK Late cut, if any Net payable amount (Provision to add multiple supply Invoices) 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 ....
X X X X Extracts X X X X
X X X X Extracts X X X X
....istics 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 scanne....
X X X X Extracts X X X X
X X X X Extracts X X X X
....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. DECLARATION / UNDERTAKING 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.....
X X X X Extracts X X X X
X X X X Extracts X X X X
....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 Central Excise Division is given as follows: Yours faithfully, Signature (Authorized Signatory) Full Name Designation Name of the Company Telephone Number Address Fax No. E-mail address 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 Central Excise 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 Central Excise Division for cross verification. ANNEXURE-III DISCLAIMER CERTIFICATE FOR NOT CLAIMING DEEMED EXPORT BE....