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Notification No. 65 dated 17th October 2001 (NT)
In exercise of powers conferred by rule 9 of the Central Excise (No.2)
Rules, 2001, the Central Board of Excise and Customs hereby makes the following
amendments in the Ministry of Finance (Department of Revenue), Notification No.
35/2001-Central Excise (N.T.) dated the 26th June, 2001, namely:
In the notification,
(a) for
Annexure-l, the following shall be substituted namely:
�Annexure I
Original
Duplicate
FORM A �1
REQUEST FOR CENTRAL EXCISE REGISTRATION
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Complete this Form for Registration with the Central Excise Department
under provisions of rule 9 of the Central Excise (No. 2) Rules, 2001. For more
information, refer to the said rules and relevant instructions.
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Part � l. Identification of Business requiring registration
(manufacturing, warehousing, dealer in CENVATABLE goods)
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1. Legal Name of the Business
2. Permanent Account Number (PAN)
(Issued by the Income Tax Department) (Self attested copy
to be enclosed)
3. Specify (Tick the box):
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Manufacturer
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Warehouse
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Manufacturer�s Depot
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Dealer
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4. Address of the Business
Telephone Nos.
Fax Nos.
E-mail Address
5. Define boundaries of the premises to be registered
6. Address of Head Office, if any
Telephone Nos.
Fax Nos.
E-mail Address
7. Name designation and address of contact person/ authorised person:
Last Name
First Name
Middle Name
Designation
Permanent Account Number (PAN)
Issued by the Income
Tax Department)
Address
Telephone Nos.
Fax Nos.
E-mail Address
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PART - II. Registration number and other details of OTHER existing
business
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1. Specify (Tick the box):
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Manufacturer
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Warehouse
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Manufacturer�s Depot
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Dealer
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2. Registration No.
3. Legal Name of the Business
4. Address of the Business
Telephone Nos.
Fax Nos.
E-mail Address
Please furnish the aforesaid information for each of the other such
factory (ies)/ warehouse (s)/ dealer�s premise (s).
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PART � lll. Details of Proprietor/ Partners/ Directors and Managing
Director
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1. Individuals- Permanent Account Number (PAN)
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Proprietor
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Partner
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Director/ Managing Director
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Last Name
First Name
Middle Name
Address
1. Has the applicant ever owned any business in the past?
A. Name of the Business
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