Annexure B

Name of the assessee with the address:

Type of Firm : Manufacture
Division !an"e :
!e"istration No :
Finished #roduct Manufactured:
$ %hapter &eadin" :
Main !aw Materia' (sed :
Benefit of any Notification is )een avai'ed :
*ast'y Audited :
++ ,tatement showin" the c'earance va'ue in the 'ast three years in !s- ./////0-
1ear &ome
%'earance
2xemption
%'earance
vide any
Noti- No-
2xport under
(T+3
2xport under
%T+4
2xport
under %T+3
2xport under
!e)ate
5/33+35 nil nil nil Nil Nil
5/35+34 nil nil nil nil
5/34+36 nil nil nil nil
++,tatement showin" the %envat %redit Avai'ed $ (ti'ised in the 'ast three years in !s- .7/////0-
1ear 8p-)a'
3
st
Apri'
!M
%envat
%redit
!M
Add'-
Duty
credit
,ervice
Tax
%redit
%apita'
%envat
%redit
Tota'
%envat
%redit
avai'ed
Tota'
%envat
%redit
uti'i9ed
.a0
Duty
paid
)y
#*A
.)0
Tota'
2xcise
Duty
paid
.a:)0;<
%envat
!atio in
=
.a0x3//
.c0;.d0
5/33+35
5/35+34
5/34+36
++,tatement showin" the >a'ue of Materia' %onsumed ; .!M: ?@# : FA0 with va'ue of ,a'esB in
Cuantity .D"-0 $ >a'ue !s- .7///0 in the 'ast three years-
1ear 8penin"
,tocE
>a'ue !s
.a0
Materia'
#urchase
>a'ue !s-
.)0
%'osin"
,tocE
>a'ue !s-
.c0
Materia'
%onsumed
Cty- .D"0
.d0
Materia'
%onsumed
>a'ue !s-
.a:)+ c0 ; .e0
,a'es
Cty.D"0
.f0
,a'es
>a'ue
!s-
."0
#ercenta"e
of >a'ue
addition
."0 .e0 3//
5/33+35
5/35+34
5/34+36
++,tatement showin" the !aw Materia' (sed ; . !M : ?@#0 a"ainst the Fuantity manufacture in the
'ast three years in .D"-0
1ear 8penin" !M :
?@# Cty-
.D"-0
.a0
!aw Materia'
#urchase Cty-
.D"-0
.)0
%'osin" !M
:?@# Cty-
.D"-0
<
Net input !M
:?@# Cty-
.D"-0
.a:)+ c0 ; .d0
Cuantity
Manufacture
.D"-0
.e0
@nput output
!atio in =
.e0 x3//d;.f0
5/33+35
5/35+34
5/34+36
Annexure+A
,tatement showin" the ,a'es !econci'iation of the Ba'ance ,heet for the 'ast three years :
.Fi"ures in !s- 7*acs0
#articu'ars 5/33+35 5/35+34 5/34+36
Sales Value as per Balance Sheet
Add : Sales return / Rate diff ./ Disc. (if any)
Tota' Aross ,a'es :
*ess : Excise duty paid
Vat paid
Aross ,a'es .exc'udin" dutytax0 :
*ess : Labour nco!e/"ob #or$ char%es (if any)
&radin% Sales (if any)
'ther nco!e (if any)
Tota' Net 2xcise ,a'es as per Ba'ance+,heet :
.Domestic sa'es : 2xport sa'es0
Sales fi%ure as per E.R.( returns )
( *o!e + Export clearance ,alue + nput as such )
Difference if any . ++ 0