ANNEXURE-9
Pass Out Document
[For removal of Liquid gases in terms of rule 8]
Serial No._______________
Original
Duplicate
Triplicate
- Name & Address of the manufacturer
_____________________________________________
- Registration Number
______________________________________________________________
- New ECC Number:ccccccccccccccc
- Range: ________________ Division: _____________ Commissionerate
_________________
- Date of Removal--__________________ Time of Removal_________________
Part-I
| (1) Description of the goods and its Tariff Sub-Heading No.
|
|
| (2) Lorry Tanker Registration No. |
|
| (3) Gross Weight of the loaded tanker at the time of despatch
|
Kg. M3 |
| (4) Tare Weight of Lorry Tanker |
Kg. |
| (5) Net Weight of goods despatched [(3) – (4)] |
Kg. M3 |
- Duty leviable on the Net Weight of goods despatched (calculated
provisionally):
Rs._____________________________________________________________________________
(In
words)(Rupees)________________________________________________________________
Provisional Entry No. in Daily Stock
Account____________________________________________
Part-II
(i) Supply Schedule
| Sl. No. |
Name of the Customer |
Delivery Note No. |
Quantity of
Goods
delivered |
Time |
Customer’s Signature |
To be filled latest by the next working day
of the return of Lorry Tanker in the factory |
| |
|
|
Kg. M3 |
In |
Out |
|
Invoice No. & date |
Final Duty |
Entry No. in Daily Stock Account |
| 1. |
|
|
|
|
|
|
|
|
|
| 2. |
|
|
|
|
|
|
|
|
|
| 3. |
|
|
|
|
|
|
|
|
|
| 4. |
|
|
|
|
|
|
|
|
|
| 5. |
|
|
|
|
|
|
|
|
|
(ii)
| 1. |
Quantity of goods returned to factory in lorry tanker
|
Kg. M3 |
| 2. |
Quantity of goods lost in transit & other losses, if any
|
Kg. M3 |
I/we hereby solemnly declare that information above is true and correct in all
respects.
Signature of the Registered person or his authorised agent
(iii)Undertaking
I/We am/are taking clearance of the aforesaid goods under special procedure as
per Commissioner of Central Excise permission F.No.__________________ dated
_______ under a specific condition that any quantity not shown as delivered to
the customer/consignees including the quantity attributable to all kinds of
losses will be liable to full payment of duty by me/us. Accordingly, I/we hereby
undertake that I/we will pay central excise duty on the entire quantity of such
unaccounted goods including all types of losses at the highest effective rate
prevailing on the date of removal of the consignment.
Place
Date
Signature of the Registered person or his authorised agent
