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Annexure

ANF 8A

Application for payment of interest on delayed refund of DutyDrawback (DBK) !erminal "xcise Duty (!"D) on deemed exports#entral $ales !ax (#$!) on supplies to "xport %riented &nits ("%&)

' "# Details*+(i) IEC Number:-(ii) Date of Issue:-(iii) Issuing Authority:-

, Applicants- details*+

(i) Name:-(ii) Address (Registered Office in case of companies and ead Office incase of others):-

(iii) !e"ephone:-

. Application $ubmission Details*+(i) Name of the concerned Regiona" Authority (RA)# De$e"opment

Commissioner (DC):-(ii) Date on %hich app"ication for c"aim %as fi"ed:-

(iii) Amount of !ED# D&'# C! c"aim sanctioned:-(i$) i"e no* and date of the c"aim sanctioned:-($) Number and date of the che+ue issued:-

/ Details of main claim

i) ,hether Duty Dra%bac: .es#No

ii) ,hether !ermina" E/cise duty : .es#No

iii) ,hether Centra" a"es !a/: .es# No

i$) i"e No* of the Regiona" Authority# DC %here main c"aim %as fi"ed and

sett"edi$) Amount c"aimed as D&'# !ED# C!

$) Amount sett"ed by Regiona" Authority# DC %ith che+ue No* and date

$i) Date of appro$a" of the c"aim as communicated to the app"icantthrough standard "etter by the Regiona" Authority# DC (attach a photo copyof the Appro$a" 0etter for ripe c"aims issued by Regiona" Authority# DC)*

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$ii) Amount of interest c"aimed 123 p*a* simp"e interest %hich shou"d beca"cu"ated from the date of one month after the date of appro$a" ti"" thedate of issuance of che+ue in sett"ement of the c"aim (attach ca"cu"ationsheet)*

Note:-(i) No interest is payab"e upto one month of its fina" appro$a" byRA# DC*

(ii) If c"aim is not sett"ed %ithin one month of fina" appro$a" of thec"aim due to any reasons4 the RA# DC %i"" ca"cu"ate interest

on appro$ed c"aim upto the date of payment of the c"aim (dateof che+ue)*

Enc"osures:- (i) 5hoto copy of appro$a" "etter for ripe c"aims*

(ii) 5hotocopy of for%arding "etter of che+ue a"ong%ith photocopy of the che+ue*

(iii) Ca"cu"ation sheet for interest c"aimed*

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0&D"1N"$ F%2 A331#AN!$

For payment of interest on delayed refund of duty drawback/terminal

excise duty on deemed exports/ CST on supplies to EOU.

6* App"ication has to be fi"ed for c"aiming interest if !ermina" E/cise Duty

(!ED)# Duty Dra%bac# Centra" a"es !a/ (C!) due to a c"aimant isnot paid %ithin a period of one month from the date of fina" appro$a" ofc"aim by the Regiona" Authority (RA)# De$e"opment Commissioner(DC)4 pecia" Economic 7one (E7)*

8* App"ication in dup"icate to be fi"ed %ithin 9 days of the date of che+ueissued to%ards sett"ement of the c"aim*

;* App"ication has to be fi"ed in AN*

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i) 5hotocopy of appro$a" "etter for ripe c"aims*

ii) 5hotocopy of for%arding "etter of che+ue a"ong%ith photocopy ofthe che+ue*

iii) Ca"cu"ation sheet for interest c"aimed*

i$) Any additiona" document re"e$ant for c"aiming interest onde"ayed payment*

D"#1A2A!%N &ND"2!AKN0

' I#,e hereby dec"are that the particu"ars and the statements made in this

app"ication are true and correct to the best of my # our no%"edge and be"ief

and nothing has been concea"ed or he"d there from* If found incorrect or

fa"se4 it %i"" render me # us "iab"e for any pena" action or other

conse+uences as may be prescribed in "a% or other%ise %arranted*

, I#,e undertae to abide by the pro$isions of !(D?R) Act4 the Ru"es and

Orders framed there under4 the !54 &5 $64 &5 $8 and the I!C()

C"assification of E/port ? Import Items*

. I # ,e hereby certify that none of the 5roprietor# 5artner(s) # Director(s) #

'arta # !rustee of the firm # company4 as the case may be4 is # are a

5roprietor # 5artner(s) # Director(s) # 'arta # !rustee in any other firm #

Company %hich has come to the ad$erse notice of D@!*

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/ I#,e hereby certify that the 5roprietor#5artner(s)#Director(s)#'arta#!rustee4

as the case may be4 of the firm#company is#are not associated as

5roprietor#5artner(s)#Director(s)#'arta#!rustee in any other firm#company

%hich is in the caution "ist of R&I*

4 I#%e further dec"are and undertae that I#%e sha"" immediate"y refund the

amount of interest obtained by us if it is found to be in e/cess of our

entit"ement upon post-issue scrutiny by @o$ernment# Audit# concerned

authority*

5 I# ,e fu""y understand that any information furnished in the app"ication if

found incorrect or fa"se %i"" render me# us "iab"e for any pena" action or

other conse+uences as my be prescribed in "a% or other%ise %arranted*

6 I hereby certify that I am authorised to $erify and sign this dec"aration as

per paragraph 9*9 of oreign !rade 5o"icy*

ignature of the App"icant 5"ace

Name Date

Designation

Officia" Address!e"ephone

Residentia" Address

Emai" Address