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Central Excise - Appendices And Forms, Annexure-17


Serial Number______/___-___ (Financial Year).



Certificate for procurement of excisable goods for export without payment of duty

This is to certify that,

  1. The exporter has furnished a Bond in Form [Specific/General]* for Rs___________________, which has been accepted by the Assistant Commissioner of Central Excise/the Deputy Commissioner of Central Excise in F.No.___________________on the_________day of the_________(month)________ (Year).


    Mr./Messers.____________________________(Name and address) is/are registered under rule 9 of Central Excise (No.2) Rules, 2001 in this Range, having registration number___________________________has furnished an undertaking in the form specified under Notification No. /2001-Central Excise (N.T.) dated to the Assistant Commissioner of Central Excise/the Deputy Commissioner of Central Excise, _____________________(Name of the Division or the Office) who has accepted the undertaking in F.No. _______________________ on the _________day of the ___________(month) ___________ (Year).

  2. The above-said exporter/manufacturer-exporter is permitted to obtain excisable goods for export under rule 19 of the Central Excise(No.2) Rules, 2001 as per details specified overleaf. This certificate is valid upto one year from the date of issue specified below.

Name and Signature of the
Superintendent of Central Excise


(Address of the RangeOffice)

To be filled by the exporter
For Procuring Goods under the procedure specified under
Notification No.42/2001-CE(N.T.), dated 26th June, 2001
issued rule 19 of the Central Excise (No.2) Rules, 2001

Name and address of the factory/ __________________________________________
warehouse/place of storage of the supplier ___________________________________

Registration Number of the factory/warehouse _________________________________

Details of the goods to be procured

Sl. No.Description QuantityValueDuty involved

I hereby declare that I have made a provisional debit of Rupees ............................................. (in both words and figures) in the Bond Account at serial No….................................. dated ..................... and on this day and after the abovementioned debit, the balance in the Bond Account is Rs..................


Please find attested copy of the specific bond/Undertaking details of which is specified by the Superintendent of Central Excise,____________________ (address) overleaf.

(Dated signature of the Exporter(s)
or his/ their authorised agents
and their seal

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