Paperwork Samples

Reference Card
Commercial Invoice
Packing List
Shipper's Letter of Instructions
SDF Form
Non-DG Declaration
GR Waiver Form (for Free Trade Sample)
GR Waiver Form (for Repair & Return)
Negative Declaration
TSCA Certificate
Annexure C1 for EOU
Annexure D for DEPB
Appendix II for Advance License
Annexure I for Drawback
Annexure II for Drawback
Appendix III for Drawback
Appendix IV for Drawback
 FREIGHT SHIPMENT PAPERWORK CHECKLIST
Mandatory Paperwork
> Commercial Invoice (6 original copies)
> Packing List (6 original copies)
> Shipper's Letter of Instructions^^

COMMODITY PAPERWORK
Garment Shipment
COMMODITY CATEGORY

Export dutiable commodities Agriculture, Animal based, Plant derivatives products.

Silk Fabric (Contains 80% or More Silk)
Silk Garments (Contains 70% or More Silk)
Leather Shipment
Software
Electronics/ Engineering Goods/ Automobiles
Pharmaceuticals/ Drugs
Liquids & Chemicals
Handicraft Shipments
* M/C #
D GSP/ Certificate of Origin C
O ARE 1 if goods are excisable C
O SDF Form two copies M&
COMMODITY PAPERWORK

O/D Phytosanitary Certificate (Quarantine) M

D Negative declaration M
O Leather Declaration/CLRI Sample M
D TSCA Certificate Only for US M
O MODVAT Declaration C
O STPI Approval M
O Softex Form M&
O/D Lab Analysis Report C
O Drug License C
O Non DG Declaration M
O MSDS M
O Non-antique certificate M
SCHEMES PAPERWORK
Exhibition Goods
Repair and Return
FREE TRADE SAMPLE (If invoice value > INR 25K)
DRAWBACK
SCHEMES

DEEC
DEPB
DFIA
100% EOU
EPCG
Sec 74 ( Duty Drawback)
Personal effects

* M/C #
O ITPO Invitation copy M
O GR Waiver M&
O Letter addressed to DC stating reason for export M
O Original Import BOE Triplicate Copy M
O Customs Attested Invoice (Import) Import copy M
O Chartered Engineer Certificate M
SCHEME PAPERWORK

O Drawback Declaration M
O Appendix III and IV M
O Annexure I and II Only for garments C
O DEEC Declaration M
O DEEC License Copy M
O Declaration for Imported/ Indigenous article M
O DEPB Declaration (Annexure D) M
O DFIA Declaration M
O DFIA details of Input and Output (in Duplicate) two copies M
O Annexure C1 M
O Sealed Envelope to ACC from Excise M
O EPCG declaration M
O Copy of passport, ticket and departure certificate M
* - "O" Represents ORIGIN paperwork requirement
"D" Represents DESTINATION paperwork requirement
"O/D" Represents that the paperwork specified is required for both ORIGIN as well as DESTINATION Customs clearance.
# "M" Mandatory paperwork
"C" Conditional papework
** Either Single Country or Multiple Country declatation is applicable.

& SDF, GR Form, GR Waiver Form and Softex form are complimentary. Only one of these is required in any case.
PLEASE NOTE THAT WE DO NOT PICK UP following Non-branded Items: Pharmaceuticals, food products, edible oil and sugar

Created By: Sushil Verma Version Control by DHL India Operations Version: 1.1
 INVOICE
Shipper Invoice No. & Date Exporter Ref.

Buyer's Order No. & Date

Other reference(s)

ctc person Buyer ( if other than consignee )

Tel.No.s
Consignee

Country of origin of goods Country of final destination

ctc person
Tel No.s Terms of Delivery & payment
Pre-Carriage by Place of Receipt by pre-carrier CIF / C&F / FOB

Vessel / Flight No. Port of Loading

Delhi Payment Terms:
Port of Discharge Final Destination DP / DA / AP /

Marks & Numbers. No. & kind of Description of Goods Quantity Rate Amount
Container No. Packages

Amount chargeable : Total

( in words / currency )

Declaration:
We declaration that invoice shows the actual price of goods Signature / Date / Co stamp.
described and that all particularss are true & correct.
INDEX!A1
 PACKING LIST
Exporter Invoice No. & Date Exporter Ref.

Buyer's Order No. & Date

Other reference(s)

Buyer ( if other than consignee )

Consignee

Country of origin of goods Country of final destination

Handling information if any:

Pre-Carriage by Place of Receipt by pre-carrier

Vessel / Flight No. Port of Loading

NA Mumbai ( BOM )
Port of Discharge Final Destination Net weight: Gross weight :

Marks & Numbers. No. & kind of Description of Goods Quantity Remarks
Container No. Packages

Carton No.
Box No. ** L X B X H cms3 / 6000 =
L ( cms ) X B ( cms ) X H ( cms )
1)
2) Volumetric weight: Kgs
3)
4)
5) Actual weight: Kgs
6)
7) Total Net weight Kgs
8)
9) Total Gross weight Kgs
10)
Signature / Date / Co stamp.
 SHIPPER' S LETTER OF INSTRUCTIONS
Shipper Name: Midea Home Appliances (India) Pvt. Ltd. Date: 8/6/2018
Consignee Name: Great Harmony Logistics Limited Invoice No. LAB_India_040618_01

IE CODE NO (10 DIGIT) : 511051972

PAN NUMBER : AAHCM1911E
GSTIN NUMBER : 06AAHCM1911E1ZX
IGST Payment Status : A) Not Applicable B) LUT – Export under Bond. C) Export Against Payment
If B , Undertaking of Bond provided ? : Yes No If C, mention the taxable & IGST Amount :
End use code
DBK Serial Number Refer Enclosed Annexure MEIS Yes No
BANK AD CODE # (PART I & II) :
CURRENCY OF INVOICE USD
INCOTERMS : F O B / C & F / C & I / C I F : FOB
NATURE OF PAYMENT * : D P / D A / A P / OTHERS Others
Details to be declared for preparation of Shipping Bill
FOB VALUE :
FREIGHT (IF ANY) :
INSURANCE (IF ANY) :
COMMISSION (IF ANY) :
DISCOUNT (IF ANY) :
Description of Goods to be declared on Shipping Bill NO. OF PKGS. :
Free of cost AC Compressor samples without gas to be sent to china for testing 1
NET WT. :
8
GROSS WT. :
10
Description of Goods to be declared on AWB VOLUME WT. :
Free of cost AC Compressor samples without gas to be sent to china for testing DIMENSION (IN CMS) of each pkg.

50*36*52
L X B XH
Special Instructon, If any

TYPE OF SHIPPING BILL ( CIRCLE YES or NO) BELOW DOCUMENTS REQUIRED WITH SHIPMENT
a) FREE TRADE SAMPLE (NON-COMM) YES / NO FREE TRADE SAMPLE - VALUE FOR CUSTOMS - NOT FOR SALE
b) DUTY FREE COMMERCIAL YES / NO NOTHING SPECIFIC
c) EOU SHIPPING BILL YES / NO ANNEX C1 & ARE-1 & SDF FORM
d) DUTY DRAWBACK YES / NO DBK SL NO, ANNEX I, II, III, SDF FORM,(LEATHER DECLARATION)
e) DUTIABLE SHIPPING BILL YES / NO RATE OF CESS/ DUTY TO BE PAID AT CUSTOMS
f) DEPB SHIPPING BILL YES / NO DEPB GROUP CODE/SL NO., SDF FORM, DEPB DECL
g) DFIA YES / NO DFIA LIC/RECEIPT NO., FORM SDF, CONSUMPTION SHEET, SION NO.
h) EPCG SHIPPING BILL YES / NO REGN NO. & DT OF EPCG LIC, COPY OF EPCG LIC/REGN COPY,SDF FORM
i) ADVANCE LICENCE SHIPPING BILL YES / NO REGN NO. & DT OF ADV LIC, COPY OF LIC/REGN COPY,CONSUMPTION SHEET/SDF FORM
j) REPAIR & RETURN YES / NO ORGINAL B/E, IMP INV/PKG LIST/GR WAIVER ON GR FORM,CHARTERED ENGG CERTIFICATE, EXPORT
k) DUTY DRAWBACK (SECTION 74) INVOICE/PKG
YES / NO ORIGINAL B/E,LIST
IMP INV/PKG LIST/GR WAIVER, EXPORT INV/PKG LIST,AUTHORITY LETTER ADDRESSED
6 TO DEP. COMMISSIONER.
1. INVOICE (4 COPIES) 7. ARE-1 FORM IN DUPLICATE 13 APPENDIX III
2. PACKING LIST (4 COPIES) 8. VISA/AEPC ENDORSEMENT 14 ANNEXURE 1
3. SDF FORM IN DUPLICATE 9. LAB ANALYSIS REPORT 15 LETTER TO DC
4. NON-DG DECLARATION 10. MSDS 16 PATMENT ADVICE
5. PURCHASE ORDER COPY 11. PHYTOSANITARY CERT 17 ___________________________
6. GR FORM/GR WAIVER 12. GSP CERTIFICATE 18 ___________________________

Please indicate API (As per Invoice) if any detail is mentioned in the Invoice.
We hereby confirm that the above details declared are true and correct.
We confirm that our company's IEC & Bank AD Code Details
are registered with EDI System of Air Cargo where the clearance is being done.
* LC (Letter of Credit) Shipments are not handled by DHL SIGNATURE OF EXPORTER/STAMP
 Drawback Annexure

A new declaration is being added for the exporter to certify that no

input tax credit of CGST/IGST has been availed for any of the inputs or
input services used in the manufacture of the export goods, or that no
refund of IGST paid on export goods shall be claimed. For the transition
period, i.e. till the exporters continue to have used inputs on which CENVAT
was paid, there will be 3 declarations:

DBK001 - "I declare that no input tax credit of the Central Goods
and
Services Tax or of the Integrated Goods and Services Tax has been
Availed for any of the inputs or input services used in the
manufacture
Of the export goods YES

DBK002 - "I declare that no refund of Integrated Goods and

Services Tax paid on export goods shall be claimed."
YES

DBK003 - "I declare that CENVAT credit on the inputs or input

Services used in the manufacture of the export goods has not been
Carried forward in terms of the Central Goods and Services Tax
Act,
2017."
YES

For Every Item where DBK claimed is suffix as A or C, an exporter is required to declare
codes only, i.e. (1) DBK001 or DBK002 and (2) DBK003
 that no
e inputs or
or that no
transition
hich CENVAT

NO

NO

NO

required to declare two

003
 APPENDIX I INDEX!A1
FORM SDF

Shipping Bill No. ___________________ Date :____________

Declaration under Foreign Exchange Regulation Act, 1973 :

1. I/We hereby declare that I/We am/are the *SELLER/CONSIGNOR of the

goods in respect of which this declaration is made and that the particulars given
in the   Shipping Bill no ______________ dated ________________are true and
that,

A)* The value as contracted with the buyer is same as the full export value in the
above shipping bills.

B)* The full export value of the goods are not ascertainable at the time of export
and that the value declared is that which I/We, having regard to the prevailing
market conditions, accept to receive on the sale of goods in the overseas market.

2. I/We undertake that I/We will deliver to the bank named herein
_______________ the foreign exchange representing the full export value of the
goods on or before @ ___________________ in the manner prescribed in Rule 9
of the Foreign Exchange Regulation Rules, 1974.

3. I/We further declares that I/We am/are resident in India and I/We have place
of Business in India.

4. I./We am/are Or am/are not in Caution list of the Reserve Bank of India.

Date : -

For                             

(Signature of Exporter)

Name:                            
 (THIS IS REQUIRED ON SHIPPER’S COMPANY LETTER HEAD)

SHIPPER CERTIFICATE FOR NON-DANGEROUS GOODS

We herby certify that the contents of the consignment are not dangerous and are not
dangerous of carrying by air according to the current edition for IATA dangerous goods
regulation and all the applicable carrier and government regulation. We acknowledge that we
may be liable for dangerous resulting from any misstatement for omission and we further
agree that any air carrier involved in the shipment of the consignment may rely upon this
certificate. There is safe for air transport.

1. NO. OF PACKAGES :

2. PRODUCT NAME : ______________________________

3. GROSS WEIGHT : ______________________________

4. NET WEIGHT : ______________________________

5. DESTINATION : ______________________________

6. CONSIGNEE ADDRESS : ______________________________

7. AWB NO. : ______________________________

8. NOTIFY ADDRESS : ______________________________

For

NAME : ______________________________

DESIGNATION : ______________________________
 FREE TRADE SAMPLE
SAMPLE OF BANK CERTIFICATE FOR FREE TRADE SAMPLE

(On the Bank's letterhead)

Dated: ________________

To,

____________________

Subject: Certificate of Free Trade Sample

We certify that to the best of our knowledge and belief, the Free Trade Sample shipment being exported
(details of which are given below) does not involve any transactions in foreign exchange as informed by the
clients.

Name & Address of Shipper:

Name & Address of Consignee:

Description with clear model/serial/part number:

Invoice number and Date:

Value of Goods as per Invoice:

Kindly allow the export of the above detailed goods on Repair & Return basis on completion of necessary
customs and legal formalities.

Thank you,
For, (Bank's Name)

Authorized Signatory
INDEX!A1
 REPAIR AND RETURN
SAMPLE OF BANK CERTIFICATE FOR REPAIR AND RETURN

(On the Bank's letterhead)

Dated: ________________

To,

____________________

Subject: Certificate of Re-Export

We certify that to the best of our knowledge and belief, the Re-export (details of which are given below)
does not involve any transactions in foreign exchange as informed by the clients.

Name & Address of Shipper:

Name & Address of Consignee:

Description with clear model/serial/part number:

Invoice number and Date:

Value of Goods as per Invoice:

Reason:

Kindly allow the export of the above detailed goods on Repair & Return basis on completion of necessary
customs and legal formalities.

Thank you,
For, (Bank's Name)

Authorized Signatory
INDEX!A1
 Negative Declaration
(Negative declaration is required to be submitted by the Shipper when exporting Silk Garments, Fabric, Made-ups, where the content is
more than 70%, to the USA)

I, ________________________________ declare that the articles described below and

covered by the invoice of entry to which this declaration relates are not subject to SECTION

204 Agricultural Act of 1956, as amended (7 USE 1854) and the information set forth in this

declaration is correct and true to the best of my information, knowledge and belief.

Marks of identification Description of Article & Country of Origin

Numbers Quantity

Made in India

Date : __________________________________________

Name : __________________________________________

Signature : __________________________________________

Title : __________________________________________

Company : __________________________________________

Address : __________________________________________
TOXIC SUBSTANCES CONTROL ACT (TSCA)
CERTIFICATION INDEX!A1

Date :

(Check one section only)

[ ] POSITIVE CERTIFICATION:

    "I certify that all chemical substances in this shipment comply with all applicable rules
and orders under TSCA and that I am not offering a chemical substance for entry in
violation of TSCA or and applicable rule or order hereunder."

OR

[ ] NEGATIVE CERTIFICATION:
    "I certify that all chemicals in this shipment are not subject to TSCA."

Company Name:

Company Address:

Authorized Name:

Authorized Signature: _________________________

Title:

AIR WAYBILL:

If the certifier is unsure if them chemical substance is subject to TSCA compliance,

contact the environmental protection agency, TSCA Assistance Office, D. C. (202) 554-
1404 between 8:30 a.m. - 5:00 p.m. E.T

Date :
 APPENDIX -C1 INDEX!A1
OFFICE OF THE SUPERINTENDENT OF CENTRAL EXCISE

Range __________________ Division ___________________

Commissionerate ____________________________________
C. No.              Date              Shipping
Bill No.*         Date

1.Name of EOU :
2.IEC No. (of the EOU) :
3.Factory address :
4.Date of examination :
5.Name and designation of the examining :
  Officer-Inspector/EO/PO
6.Name & designation of the supervision :
  Officer-Appraiser/Superintendent
7. (a)Name of Commissionerate/Division/Range :
  (b)Location Code** :
8.Particulars of Export Invoice :
  (a)Export Invoice No. :
  (b)Total No. of packages :
  (c)Name and address of the consignee abroad :
9.(a)Is the description of the goods, the Quantity and their value as per :Yes/No
particulars furnished
   (b)Whether sample inis the
drawnexport invoice?
for being forwarded to port of export? :Yes/No
10.(a)For Non-containerized cargo
      Nos. of packages :Seal Nos
    (b)For Containerized cargo :
      Container No.               Size Seal No.

 Signature of Signature of Signature of

Exporter Examiner/Inspector Appraiser/Superintendent
Name : _____________ Name : _____________ Name : _____________
Designation : _________ Designation : _________ Designation : _________
Stamp: Stamp: Stamp:
Note:

1. The office supervising the examination should attest Invoice(s) and any other document accompanying this document.
2. * To be filled in by the exporter before filing of this document at the time goods registration in the export shed.
3. * Revised 6 digit code as assigned by the Directorate of S & I, XXYYZZ
XX Commissionerate
YY Division
ZZ Range
 A P P E N D I X -- I I (ANNEXURE D)
DEPB DECLARATION
( To be filled for export goods under claim for drawback )

Shipping Bill No. and Date:- / 2000

I / We ( Name of the Exporter ) do hereby

further declare as follows:-

1) That the quality and specification of goods as stated in this Shipping Bill are in accordance with the terms of
exports contract entered into with the buyer / consignee in pursuance of the goods which are being exported.

2) That we are not claiming benefit under " Engineering Products Export ( Replenishment of Iron and Steel
Intermediates ) schemes" notified vide Ministry of Commerce Notification No.539 RE / 92-97 dated 01.03.95.

3) That there is no change in the manufacturing formula and in the quantum per unit of the imported material or
components,utilised in the manufacture of theexport goods, and that the materials or components which have
been stated in the application under Rule 6 or Rule 7 of the of Drawback Rules 1995 to have been imported
continue to be so imported and are not been obtained from indigenous sources.

4) * ( A ) That the export goods have not been manufactured by availing the procedure under Rule 12(1)(b)/13(1)(b)
of the Central Excise Rules,1944.

OR
* ( B) That the export goods have been manufactured by availing the procedure under rule 12(1)(b)/13(1)(b) of the
Central Excise Rules,1944,but we are / shall be claiming DBK on the basis of special brand rate in terms of Rule 6
1995)

5) *( A ) That the goods are not manufactured and / or exported in discharge of export obligation against an
Advance license issued under the Duty Exemtion Scheme (DEEC) vide relevant import and Export policy
in force.
OR

* ( B ) That goods are manufactured and are being exported in discharge of export obligation under the
Duty Exemption Scheme ( DEEC ) , in terms of Notification 79 / 95 Cus,or 80/85 Cus, both dated
31.03.95 or 31/97 dated 01.04.97 but I / We are claiming Drawback of only the Central Excise portion
of the duties on inputs specified in the Drawback Schedule.

* ( C ) That the goods are manufactured and are being exported in discharged of export obligation
under the duty exemption scheme ( DEEC ), but I / We are claiming Brand rate of fixed under Rule 6 or
& of the DBK Rules,1995.
* ( Strike out which ever is inapplicable)

6) That the goods are not manufactured and / or exported after availing of the facility under the Passbook
Scheme as contained in para 7.25 of the Export and Import Policy ( April,1997-31st March,2002).
7) That the goods are not manufactured and / or exported by unit licensed as 100% Export Oriented Unit in terms
of Import and Export Policy in force.

8) That the goods are not manufactured and / or exported by a unit situated in any Free Trade Zone / Export
Processing Zone or any other such Zone.

9) That the goods are not manufactured partly or wholly in bond under Section 65 of the the Customs Act,1962.

10) That the present market value of the goods is as follow :-

S. No. Item No. In Invoice Market Value

11) That the export value of the goods covered by this Shipping Bill is not less than total value of all
imported materials used in manufacture of such goods.

12) That the market price of the goods being exported is not less than the drawback amount being
claimed.

13) That the drawback amount claimed is more that 1% of the FOB value of the export produst,or the
drawback amount claimed is less than 1% of the FOB value but more than Rs.500/- against the
Shippin Bill.

14) I / We undertake to repatriate export proceeds with 6 months from date of export and submit BRC
to Asst: Commissioner ( Drawbck ) In case,the export proceed are not realised within 6 months
from the date of the export, I / We will either furnish extension fo time frm RBI and submite BRC
within such extended period or will pay back the drawback received against this Shipping Bill.

Name of Exporter
Address

Signature of the Exporter

 APPENDIX II
Advance License Declaration

(To be filled for export of goods under Advance License scheme)

Shipping Bill No. & Date: _________________________________

I/We ___________________________ (name of the exporter) do hereby further declare as follows:

1.

A. That the export goods have not been manufactured by availing the procedures under rule 12(I)(b)//13(I)(b) of the Central
Excise Rules, 1994.

OR

B. That the export goods have not been manufactured by availing the procedure under rule 12(I)(b)/12(I)(b) of the Central
excise Rules, 1994 in respect of the materials permitted to be imported duty free under the relevant license except the
benefit under the notificatiion number 49/94-CE (NT) dated 22/09/94.

OR

C. That the export goods have been manufactured by availing the procedure under rule 12(I)(b)/13(I)(b) of the Central
Excise Rules, 1994.

OR

2.

A. (A) The export against this shipping bill is made directly by advance license holder

OR

B. The export against this shipping bill is being made directly by third party(s) and a contractual agreement in this regard
exists between the advance license holder and third party. all the export documents are signed by both advance license
holder and exporter. In the event of any fraud – both will be severally and jointly responsible for such fraud and liable for
penal action.

(* Strike out whichever is inapplicable)

Name of the Exporter :

Signature of the Exporter

INDEX!A1
 ANNEXURE-I
Exporters' Declaration required for Exports of Woven Garments for availing
higher All Industry Rate of Drawback.
(Circular No.54/2001-Cus, dated 19th October, 2001).
1. Description of the Goods:

2. Invoice No. and Date:

3. Name and address of the Exporter alongwith

the name of the jurisdictional Central Excise
Commissionerate/Division/Range:

4. Name of the Supporting Manufacturer (s)/

Job worker (s) alongwith the name of the
Jurisdictional Central Excise Commissionerate/
Division/ Range:

5. Address of the Manufacturing Unit(s)/

Job Work Premises:
We, M/S. ____________________, the Exporters of the above mentioned goods, hereby declare
that -
(a) we are not registered with Central Excise authorities,
(b) we have not paid any Central Excise duty on these goods, and
(c) we have not availed of the Cenvat facility under the CENVAT Credit Rules, 2001 or any
notification issued thereunder, and
(d) we have not authorized any supporting manufacturer/job-worker to pay excise duty and
discharge the liabilities and comply with the provisions of Central Excise (No.2) Rules,
2001, under the proviso to Rule 4(3) of the said Rules.
We also undertake that in case it is discovered that the Cenvat facility has been availed by us
or by our supporting manufacturers in respect of these export goods, we shall return the
excess drawback paid to us on the basis of above declaration.

Exporters' Signature & Seal

INDEX!A1
 ANNEXURE-II
Supporting Manufacturers'/Job Workers' Declaration required for Exports of  Woven Garments for availing higher All
Industry Rate of Drawback.
(Circular No.54/2001-Cus, dated 19th October, 2001).

1. Description of the Goods:

2. Invoice No. and Date:

3. Name and address of the Exporter alongwith

the name of the jurisdictional Central Excise
Commissionerate/Division/Range:

4. Name of the Supporting Manufacturer (s)/

Job worker (s) alongwith the name of the
Jurisdictional Central Excise Commissionerate/
Division/ Range:

5. Address of the Manufacturing Unit(s)/

Job Work Premises:
We, M/S. ____________________, the supporting manufacturers/job workers declare that we
(a) are not registered with Central Excise authorities,
(b) have not paid any Central Excise duty on these goods, and
(c) have not availed of the Cenvat facility under the CENVAT Credit Rules, 2001 or any
notification issued thereunder, and
We also declare that we are manufacturing and supplying garments to the above merchant
exporters only.

Supporting Manufacturers'/Job Workers' Signature & Seal

INDEX!A1
 APPENDIX III
(To be filled for export goods under claim for drawback)

Shipping Bill no. and date_____________________

I/We__________________________________do hereby further declare as follows:-

1. That the quality and specification of the foods as stated in this Shipping Bill are in accordance with the terms of the exports contract
entered into with the buyer/consignee in pursuance of which the goods are being exported.

2. That we are not claiming benefit under "Engineering Products Export (Replenishment of Iron and Steel Intermediates) Scheme"
notified vide Ministry of Commerce Notification No.539RE/92-97 dated 01.03.95.

3. That there is no chance in the manufacturing formula and in the quatum per unit of the imported material or components, if any,
utilized in the manufacture of the export goods and that the materials or components which have been stated in the application under
Rule 6 or Rule 7 to have been imported, continue to be so imported and are not been obtained from indigenous sources.

4. A. That the export goods have not been manufactured by availing the procedure under rule 191A/191B or under Rule 12(1)(b)/13(1)
(b) of the Central Excise rules,1944.

OR

B.That the export goods have been manufactured by availing the procedure under rule 191A/191B or under Rule 12(1)(b)/13(1)(b) of
the Central Excise rules,1944.

5. A. That the goods are not manufactured and/or exported in discharge of export obligation against an Advance Licence issued under
the Duty Exemption Scheme (DEEC) vide relevant Import and Export Policy in force.

OR

B. That goods are not manufactured and are being exported in discharge of export obligation under the Duty Exemption Scheme
(DEEC),but I/We are claiming drawback of only the Central Excise Portion of the duties on inputs specified in the Drawback Schedule
except for the Central Excise Portion of duties on inputs permitted import free of Addl. Duty of customs against Advance Licence.

6. That the goods are not manufactured and/or exported after availing of the facility under the Passbook Scheme as contained in para 54
of the Export and Import Policy (April. 1992 -31st March, 1997).

7. That the goods are not manufactured and/or exported by a unit licensed as 100% Export Oriented Unit in terms of Import and Export
Policy in force.

8. That the goods are not manufactured and/or exported by a unit situated in any Free Trade Zone/Export Processing Zone or any such
Zone.

9. That the goods are not manufactured partly or wholly in bond under Section 65 of the Customs Act, 1962.

10. That the present Market Value of goods is as follows:-

S.No           ITEM NO.          INVOICE         MARKET VALUE

 11. That the export value of the goods covered by this Shipping Bill is not less than the total value of all
imported materials used in manufacture of such goods.

12. That the market price of the goods being exported is not less than the drawback amount being claimed.

13. That the drawback amount claimed is more that 1% of the FOB value of the export product or the
drawback amount claimed is less than 1% of the FOB value but more than Rs.500.00 against the Shipping
Bill.

14. I/We undertake to repatriate export proceeds within 6 months from date of export and submit B.R.C to
Asstt. Commissioner (Drawback). In case, the export proceeds are not realized within 6 months from the
date of export, I/We will either furnish extension of time from R.B.I and submit B.R.C within such extended
period or will pay back the drawback received against this shipping bill.

Date___________

For (Name of Company)

NAME AND SIGNATURE OF THE EXPORTER

(* Strike out whichever is not applicable)

INDEX!A1
 APPENDIX IV
(Declaration to be filed in respect of goods for which drawback under S.S.Nos. 

03.01,03.02, 04.01, 04.02, 04.03, 07.01, 07.02, 07.03, 08.01,08.02, 08.03, 09.01, 09.02, 09.03, 16,01 16.02,
16.03, 1,7.01, 17.02, 17.03, 18.01, 18.02, 18.03. 19.'01, 19.02, 19 . 03 ,20.01 20.02 , 20.03, 20.06, 20.07, 20.10,
20.11, 20.12, 20.15, 20.16, 20.17, 21.01, 21.02, 21.03, 39..01, 39.03, 39.05, 39.06, 39.07, 39.09, 39.11, 39.12,
39.13, 39.14, 39.15, ,39.16, 3,9.18, 39.19, 39.20, 39.24, 39.25, 39.27, 39.29, 40.06, 42.01, 42.02, 42.05, 42.06,
42.07, 42.10, 42.12, 42.14, 52,.01, 52.03, 52.04, 52.05, 54.03, 54.04 54.05, 54.06, 55.01, 55.02, 55:03, 55.04,
55.05, 56,04, 58.01, 58.02, 58.03, 58.04, 60.06, 60.10, 61.02, 61.05, 61.07 62.02, 62.09, 62.10, 62.21, 63.03,
63.04, 63.061, 63.062, 63.07, 63.08, 63.10, 63.11, 64.01, 64.02, 64.03, 64.06, 64.07, 64.08, 64.09, 64.11, 71.02,
71.03, 71.05, 73.03, 73.11, 73.13, 73.15, 73.22, 74.02, 74.04, 74.05, 74.06, 74.07, 74.12, 74.17, 74.19, 74.20,
74.24, 76.03, 76.04, 82.01, 82.03, 82.031, 82.032, 83.07, 84.26, 84.54, 84.58, 85.37, 85.38, 85.39, 85.40, 85.45,
85.120, 85.154, 87.45, 90.07, 94.01, & 95.08 has been claimed).

Shipping Bill Number & Date .....................

I/We__________________________ (Name of the

Exporter) do hereby declare as follows:-

1. That no CENVAT facility has been availed for any of the inputs used in the manufacture of export products;
and

2. That the goods are being exported under bond 'or claim for rebate of Central Excise duty and a certificate from
concerned Superintendent of Central Excise, incharge of factory of production, to the effect that CENVAT
facility has not been availed for the goods under export, is enclosed (Drawback as per schedule is applicable).

(Name, Address & Signature of the Exporter)

APPENDIX V
(Declaration Lo be filed for goods falling under S.S.No.28.26,28.261,29.15,29.16,30.01,30.02)

Shipping Bill Number & Date...............

I/We __________________(Name of the Exporter) declare that the

drugs and pharmaceuticals under export are other than the following:-

1. Distilled water for injections as per pharmacopoeial standards.

2. Ayurvedic, Homeopathic, Sidha and crude drugs

3. Tincture and saline preperations

4. Medicinal Castor Oil.

5. Isogel

6. Calcium Senoside

7. (a) Gripe Water

(b) Gelatine Capsules

(c) Surgical Spirit

(d) Ether Anesthetic B.P.

(e) Sesame Oil B.P

(f) Strychnine Alkaloid

8. Senna Calcium precipitation 20%

9. Intestopan Tablets

10. Drugs and pharmaceutical products extracted/manufactured wholly or partly from plants and
animals.

11. Drugs and pharmaceutical products containing any of the goods specified in Notification
No.16/2000-Cus. dt.1.3.2000 which are fully exempted from duty.

(Name, Address & Signature of the Exporter)

APPENDIX VII
(Declaration to be filed in respect of goods of S.S.No.30.04, 30.05, 30.06, 30.07, 30.08, 30.09, 30.11,
30.12 & 30.14)

Shipping Bill Number & Date............

I/We ______________________________(Name of the Exporter) declare that:-

*1. The grammage of tablets indicates the extent of active ingredient contained in the tablets.
(Drawback as per schedule is permissible).

*2. The grammage of tablets is as shown in invoice but the active ingredient content is ________%
only and the drawback

claimed has been reduced to the percentage of active ingredient.

(*Strike out whichever is not applicable)

(Name, Address & Signature of the Exporter)

APPENDIX VIII

(Declaration to be filed in respect of goods of S.S.No.30.03) Shipping Bill Number & Date. ............

I/We ______________________________________(Name of the Exporter) declare that Mercury free

hydrochloric acid (not exceeding the limit of 0.02 ppm of mercury in hydrochloric acid) has been used
in the manufacture of export product and a certificate from Supdt. of Central Excise in this regard is
enclosed.

(Name, Address Sc Signature of the Exporter)

APPENDIX IX
(Declaration to be filed in respect of goods for which drawback S.S.Nos.48.03, 48.04, 48.05, 48.06,
48.07, 48.08, 48.09, 49.03, 49.04, 49.05, 49.06, 49.07, 49.08 & 49.09)

Shipping Bill Number & Date...................

I/We ___________________________(Name of the Exporter)

declare that the goods under export are made of only one type of paper/board and if made of more
than one type of paper/board, drawback is being claimed only on the quantity of paper falling under
S.S.Nos. 48.03, 48.04, 48.05, 48.06, 48.07, 48.08, 48.09, 49.03, 49.04, 49.05, 49.06, 49.07, 49.08 &
49.09, as the case may be.

(Name, Address & Signature of the Exporter)

APPENDIX - X

(Declaration to be filed in respect of Drawback claims for S.S.No.72.01/ 72.03, 72.05, 72.07, 72.09,
72.11, 87.13, 87.14, 87.15 87.16,87.17, 87.18, 87.19, 87.20, 87.21, 87.22, 87.23, 87.24, 87.25 87.26,
87.27, 87.28, 87.29, 87.30, 87.31, 87.32, 87.33, 87.34, 87.35 87.36, 87.37, 87.38, 87.39, 87.40,
87.41, 87.42, 87.43 & 87.44)

Shipping Bill Number & Date...........

I/We ____________________________ (Name of the Exporter) declare that the export products are
made out of only imported HR Steel/Strip/Wide Coils and such imported inputs are duty paid.

(Name, Address & Signature of the Exporter)

 APPENDIX - XI
(Declaration to be filed in respect of Drawback claims for S.S.No.73.10, 73.18, 73.20, 73.24, 84.01,
84.02,84.03, 84.04, 84.05, 84.06, 84.061, 84.062, 84.60, 84.61.,& 87.12). !

Shipping Bill Number & Dace ...........

I/We ______________________________(Name of the Exporter) declare that duty paid imported

steel has been used in the manufacture of the export product and declaration to this effect is made on
the Shipping Bill invoice and a certificate from Supdnt. of Central Excise, incharge of factory of
production to this effect is enclosed.

(Name, Address & Signature of the Exporter)

APPENDIX-XIII
(Declaration to be filed in respect of goods for which drawback under S.S.No. 84.10, 84.11 & 84.12)
Shipping Bill Number & Date...................

I/We____________________________________(Name of the Exporter) declare:-

*1. That the FOB prices as per order/contract/invoice and shipping documents for centrifugal pump
and electric motor are not available seperately in respect of "Power driven centrifugal pumps for liquids
fitted with electric motors" under export. (Drawback @ 2.5% is admissible).

*2. That the FOB. value of centrifugal pumps and electric motors is seperately available as per
order/contract and same is seperately shown on the invoice and shipping documents. We have shown
price of pumps and motors seperately in Annexure. 'B' . The value of Motor has been shown under
S.S. No______ and that of pump under S.S.No. ____

(* Strike out whichever is not applicable).

(Name, Address & Signature of the Exporter)

APPENDIX-XIV
Declaration to be filed by the exporters of Leather Articles claiming All Industry Drawback Rate in the
Drawback Table for the year 1999-2000.

I/We ..................................(Name of the Exporter)

declare that the goods exported in the S/Bill No..............dt......... are manufactured from the
indegenous finished leather in which there is no content of duty free imported leather.

Name, Address & Signature of the Exporter or his authorised agent.

INDEX!A1