FORM E.R.

1 Original / Duplicate (See Rule 12 of the central Excise Rules,2002 and Rule 7(5) of CENVAT Credit Rules . 2002)

Return of exciseable goods and availment to CENVAT credit for the month of

Large Taxpayer Unit Opted for (name of the city)*:-

1. Registration number :-

2.Name of the Assessee :-

3. Deetails of the manufacture, clrarance and duty payable CETSH NO. Description of gooods Unit of quantity OP . BAL Quantity manufactured Quantity cleared CL BAL Assessable value

3(A)

5(A)

Total Duty Notification avalied Serial number notification in Rate of duty(adv) Rate of duty (specific) Duty payable Provisional assessment number(if any)

7 Excise Duty Edu.Cess S.H.Cess Other Duites

10

11

12

13

4. Clearance details of inter unit transfer of intermediate goods without payment of duty under sub-rule(1)of rule 12BB*:Registration number of recipient unit Name and address of
the recipient premises

CETSH NO.

Description of goods sent

Unit of Quantity

Quantity cierred

5. Receipt of intermediate goods without payment of duty under sub-rule (1) of rule 12 BB*:Registration number of Name and addres sender Premises of the sender premises 2 1 CETSE NO Description receive 4 of goods Unit quantity 5 of Quantity received 6

6. Details of duty paid on excisable goods :Duty Dode Credit Accoun(Rs.) Account Current (Rs) No.4A 1 Excise Duty Edu.Cess S.H.Cess Other Duty 7. Abstract of ACCOUNT-CURRENT (Cash payment) 2 3 Challan date 4B 5 6 duty BSR code Total paid (2+3)

Summary particulars 1 Excise Duty Opening Balance Add: TR-6/GAR-7 Challan payments made in month (in aggregate) Add*.Adjustment of the excess duty paid during previous period under subrule (2) of rule ( incase of L T ) Total amount available Less:Utilization towards payment of duties on excisable goods during the month (vide. Details furnished under col.no.3 in SI. NO. (6)of the Return) Less:Utilization towards other payments made during the month ( Vide .Deatails furnished under SI.No.(9) of the Return) Closung balance

Amount in Rs. Ed Cess H.S. Cess

8. Deatails of CENVAT credit taken and utilized1 2 Details of credit CENVAT SI. No. (Rs.) 1 Opening Balace 2 Credit taken on inputs on invoices issued by manufacturers 3 Credit taken on inputs on invoices issued by I or II stage dealers

3 AED

4 NCCD

(TTA)(Rs.)

(Rs.)

5 6 AED levied under Additional duty of costoms levied clause 85 of Finance under senction 3(5) of the act.2005 costoms tariff act.1975

7 Education Cess on excisiable goods (Rs)

8 H.S. Cess

9 10 11 Servise Ed cess H.S. Cess Tax (Rs.) on taxable services (Rs.)

4 Credit taken on imported inputs 5 Credit taken on capital goos on invocies issued by manufacturers or by I or II stage dealers 6 Credit taken on imported capital goods 7 Credit taken on input services 8 Credit taken from inter-unit transfer of credit by a large taxpayer * 9 Credit taken under sub-rul (2) of rule 12bb of Central Excise Rules,2002* 10 Total Credit availble 11 Credit utilised for payment of duty on goods 12 Credit utilised when input or capital are removed as such 13 Credit utilised for payment of amt.interms of Rule 6 of CENVAT credit rules 2004 14 Credit utilised for other payment. 15 Credit utilised for payment of tax on service 16 Credit utilised towards inter-unit transfer credit by a large taxpayer * 17 Closing balance 9. Details of other payments made :Payments Amount Paid (Rs.) Challan Account current Credit Account No. Date BSR code Souse document No. Date

2A

2B

3A

3B

5A

5B

Arrears of duty under rule 8 Other arrears of duty Interest payment under rule 8 Other interest payments Misc. payments TOTAL

10. Self - Assessment Memorandum :a) I hereby declare that the information given in this retunrn is true, correct and complete in every respect and that I am authorised to sing on behalf of the assessee. b) During the month, total Rs NIL--------was deposited vide TR6 challans (copies NOT enclosed) c) During the month, invocies bearing S.No--to--were issued . d) During the month,transfer challan under rule 12 BB of the Central Exacise Rules, 2002 bearing S.No._________to_________,and transfer challan under rule 12 A of the CENVAT Credit Rule , 2004 bearing S. No.______to______ were issued.*

Place : Date : (Name of the Assessee or Authorised Signatory)