Appendix-I Application for permission to avail of the special procedure relating to pan masala and pan masala containing tobacco (Gutkha). (under Rule 15 of the Central Excise Rules, 2002) Name of the manufacturer : Address of the manufacturing premise: ECC No : Address of other premises manufacturing the same products: I/We manufacturer of pan masala or pan masala containing tobacco, residing at...........................taluka/tehsil .................... district............... hereby apply to avail of the special procedure in respect of the manufacture and removal of such goods at my/our above mentioned premise during the period beginning with...... and ending with ......20.., under the provisions of Notification No -------------CE dated issued under rule 15 of the Central Excise Rules, 2002. I/We further declare that pouch packing machine of following particulars shall be used or are used by me in the above mentioned premise and I undertake to pay the total duty payable by me in terms of the provisions laid down in the said Notification. S No Make and model of machine No. of packing machines Description goods to manufactured of be Retail sale price of the pouches to be manufactured I/We further undertake that any addition or removal of the packing machine would be done under the physical supervision of the Central Excise Officer as per the procedure provided in the notification. 2. I/We hereby agree to abide by the provisions and conditions of the said notifications throughout the said period. Place: Date: Name, residential address and signature of manufacturers or his/their authorised agent Appendix -II Intimation of payment of duty by the manufacturer of pan masala or pan masala containing tobacco under Notfication No. 38/2007-C.E. dated 19-12-2007 issued under Rule 15 of the Central Excise Rules, 2002 . Name of the manufacturer : Address of the manufacturing premise: ECC No.: I/We hereby declare that we have paid a sum of Rs. .............., toward the duty liability for the month of ....................., as per particulars given below: (i) No of packing machines installed in factory (ii) Retail Sale Price of the pouches (iii) Duty payment particulars Date of payment Name and address Amount of duty of the Bank and paid branch Copies of bank challans are enclosed ( ) Place: Date: Name, residential address and signature of manufacturers or his/their authorised agent
