Form ST-3 (Return under Section 70 of the Finance Act, 1994)

Registration Number : Return Number : Address of Registered Unit : Commissionerate : Financial Year : Single Return :

AAACJ4952HST001

Assessee's Name :

AAACJ4952HST001_SG0 Status : 2060001_ST3_042011 - R-627 MIDC TTC IND AREA, RABALE THANE GHANSOLI SERVICE TAX-II MUMBAI 2011-2012 Yes Division : SERVICE TAX DIVISION-V Return for the period :

JOGLEKAR REFRACTORIES & CERAMICS PVT LTD., FILED

Range :

GROUP-VI

April-September

Category of Service : TRANSPORT OF GOODS BY ROAD

COMPUTATION OF SERVICE TAX(TO BE FILLED BY A PERSON LIABLE TO PAY SERVICE/NOT TO BE FILLED BY INPUT SERVICE DISTRIBUTOR) A2 Assessee is liable to pay service tax on this taxable service as (i) (ii) B C1 C2 A2 1 a Service Provider : No a Service Receiver liable to make payment of service tax : Yes Sub-clause No. of clause(105) of section 65 : (zzp) Has the assessee availed benefit of any exemption notification : No If reply to above is yes, please furnish Notification Nos. : Notification No.

D E1 E2

Sr.No in the Notification (If Abatement is claimed as per Notification No. 1/2006-ST) : Whether provisionally assessed : No Provisional Assessment Order No.(If Any) :

F. VALUE OF TAXABLE SERVICE,SERVICE TAX PAYABLE AND GROSS AMOUNT CHARGED (ALL FIGURES IN RUPEES) FOR SERVICE RECEPIENT Sl.n o (I) SERVICE TAX PAYABLE (a) Gross Amount paid in money (i) Against service received : (ii) 41522 91970 167470 0 0 112981 0 0 69441 0 0 162960 0 0 646344 0 0 Apr May June July Aug Sept Total

In advance for service to 0 0 be received : (b) Money equivalent of con0 0 siderations paid in form other than money : (c) Value on which Service Tax is exempt/not payable (i) Amount paid against export of service^ : 0 0

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Amount paid towards ex0 0 empted service(other than export of service) : (iii) Amount paid to pure agent 0 0 : (d) Abatement amount claimed 0 0 : (e) Taxable value = (a+b) 41522 91970 (c+d) : Service Tax rate wise break-up of taxable value = (e) Sl.n o Taxable Rate % Service Tax Rate @ :10 Education Cess Rate @ :2 Secondary and Higher Education Cess Rate @ :1 Service tax payable = : Education cess payable : Secondary and higher education cess payable : (II) TAXABLE AMOUNT PAID Gross amount for which bills/invoices/challans are issued relating to service received/to be received (including export of service and exempted service) : Money equivalent of other considerations paid,if any,in a form other than money : Amount paid for exported service received/to be received^ : Amount paid for exempted service received/to be received (other than export of service) : Amount paid as pure agent : Amount claimed as abatement : Net taxable amount paid = (j+k) - (l+m+n+o) : Apr 41522 May 91970

(ii)

0 0 167470

0 0 112981

0 0 69441

0 0 162960

0 0 646344

Taxable Value June 167470 July 112981 Aug 69441 Sept 162960 Total 646344

4152 83 42

9197 184 92

16747 335 167

11298 226 113

6944 139 69

16296 326 163

64634 1293 646

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

Category of Service : CONSULTING ENGINEER

COMPUTATION OF SERVICE TAX(TO BE FILLED BY A PERSON LIABLE TO PAY SERVICE/NOT TO BE FILLED BY INPUT SERVICE DISTRIBUTOR) A2 Assessee is liable to pay service tax on this taxable service as (i) (ii) B C1 C2 A2 1 Page 2 of 9 a Service Provider : No a Service Receiver liable to make payment of service tax : Yes Sub-clause No. of clause(105) of section 65 : (g) Has the assessee availed benefit of any exemption notification : No If reply to above is yes, please furnish Notification Nos. : Notification No.

D E1 E2

Sr.No in the Notification (If Abatement is claimed as per Notification No. 1/2006-ST) : Whether provisionally assessed : No Provisional Assessment Order No.(If Any) :

F. VALUE OF TAXABLE SERVICE,SERVICE TAX PAYABLE AND GROSS AMOUNT CHARGED (ALL FIGURES IN RUPEES) FOR SERVICE RECEPIENT Sl.n o (I) SERVICE TAX PAYABLE (a) Gross Amount paid in money (i) Against service received : (ii) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Apr May June July Aug Sept Total

In advance for service to 0 0 be received : (b) Money equivalent of con0 0 siderations paid in form other than money : (c) Value on which Service Tax is exempt/not payable (i) Amount paid against export 0 0 of service^ : (ii) Amount paid towards ex0 0 empted service(other than export of service) : (iii) Amount paid to pure agent 0 0 : (d) Abatement amount claimed 0 0 : (e) Taxable value = (a+b) 0 0 (c+d) : Service Tax rate wise break-up of taxable value = (e) Sl.n o Taxable Rate % Service Tax Rate @ :0 Education Cess Rate @ :0 Secondary and Higher Education Cess Rate @ :0 Service tax payable = : Education cess payable : Secondary and higher education cess payable : (II) TAXABLE AMOUNT PAID Gross amount for which bills/invoices/challans are issued relating to service received/to be received (including export of service and exempted service) : Money equivalent of other considerations paid,if any,in a form other than money : Amount paid for exported service received/to be received^ : Amount paid for exempted service received/to be received (other than export of service) : Amount paid as pure agent Apr 0 May 0

0 0

0 0

0 0

0 0

0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

Taxable Value June 0 July 0 Aug 0 Sept 0 Total 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 Page 3 of 9

: Amount claimed as abatement : Net taxable amount paid = (j+k) - (l+m+n+o) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Category of Service : BUSINESS AUXILIARY SERVICES

COMPUTATION OF SERVICE TAX(TO BE FILLED BY A PERSON LIABLE TO PAY SERVICE/NOT TO BE FILLED BY INPUT SERVICE DISTRIBUTOR) A2 Assessee is liable to pay service tax on this taxable service as (i) (ii) B C1 C2 A2 1 a Service Provider : No a Service Receiver liable to make payment of service tax : Yes Sub-clause No. of clause(105) of section 65 : (zzb) Has the assessee availed benefit of any exemption notification : No If reply to above is yes, please furnish Notification Nos. : Notification No.

D E1 E2

Sr.No in the Notification (If Abatement is claimed as per Notification No. 1/2006-ST) : Whether provisionally assessed : No Provisional Assessment Order No.(If Any) :

F. VALUE OF TAXABLE SERVICE,SERVICE TAX PAYABLE AND GROSS AMOUNT CHARGED (ALL FIGURES IN RUPEES) FOR SERVICE RECEPIENT Sl.n o (I) SERVICE TAX PAYABLE (a) Gross Amount paid in money (i) Against service received : (ii) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Apr May June July Aug Sept Total

In advance for service to 0 0 be received : (b) Money equivalent of con0 0 siderations paid in form other than money : (c) Value on which Service Tax is exempt/not payable (i) Amount paid against export 0 0 of service^ : (ii) Amount paid towards ex0 0 empted service(other than export of service) : (iii) Amount paid to pure agent 0 0 : (d) Abatement amount claimed 0 0 : (e) Taxable value = (a+b) 0 0 (c+d) : Service Tax rate wise break-up of taxable value = (e) Sl.n o Taxable Rate % Apr May

0 0

0 0

0 0

0 0

0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

Taxable Value June July Aug Sept Total

Page 4 of 9

Service Tax Rate @ :0 Education Cess Rate @ :0 Secondary and Higher Education Cess Rate @ :0 Service tax payable = : Education cess payable : Secondary and higher education cess payable : (II) TAXABLE AMOUNT PAID Gross amount for which bills/invoices/challans are issued relating to service received/to be received (including export of service and exempted service) : Money equivalent of other considerations paid,if any,in a form other than money : Amount paid for exported service received/to be received^ : Amount paid for exempted service received/to be received (other than export of service) : Amount paid as pure agent : Amount claimed as abatement : Net taxable amount paid = (j+k) - (l+m+n+o) :

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

4. AMOUNT OF SERVICE TAX PAID IN ADVANCE UNDER SUB-RULE(1A) OF RULE 6 Sl.n o Amount paid in Advance : (ii) Apr 0 May 0 June 0 July 0 Aug 0 Sept 0 Total 0

Challan Details for Advance Payment Month Apr May Jun Jul Aug Sept GAR-7 Challan

4A. SERVICE TAX,EDUCATIONAL CESS AND OTHER AMOUNTS PAID(TO BE FILLED BY A PERSON LIABLE TO PAY SERVICE TAX/NOT TO BE FILLED BY INPUT SERVICE DISTRIBUTOR) Sl.n Apr May June July Aug Sept Total o (I) SERVICE TAX ,EDUCATION CESS,SECONDARY AND HIGHER EDUCATION CESS PAID (a) SERVICE TAX PAID In cash : By CENVAT Credit ^ : Advance Service Tax utilized [Rule 6(1A)] : Service Tax paid [Rule 6(3)] : 4152 0 0 0 9197 0 0 0 16747 0 0 0 11298 0 0 0 6944 0 0 0 16296 0 0 0 64634 0 0 0

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Service Tax paid [Rule 6(4A)] : (b) EDUCATION CESS PAID In cash : By CENVAT Credit ^ : Advance Educess utilized [Rule 6(1A)] : Educess paid [Rule 6(3)] : Educess paid [Rule 6(4A)] :

83 0 0 0 0

184 0 0 0 0

335 0 0 0 0

226 0 0 0 0

139 0 0 0 0

326 0 0 0 0

1293 0 0 0 0

(c) SECONDARY AND HIGHER EDUCATION CESS PAID In cash : By CENVAT Credit ^ : Advance Sec.& High. Educess utilized [Rule 6(1A)] : Sec.& High. Educess paid [Rule 6(3)] : Sec.& High. Educess paid [Rule6(4A)] : (d) OTHER AMOUNTS PAID 42 0 0 0 0 92 0 0 0 0 167 0 0 0 0 113 0 0 0 0 69 0 0 0 0 163 0 0 0 0 646 0 0 0 0

Other amounts paid - Ar0 0 0 0 0 0 0 rears Cash : Other amounts paid - Ar0 0 0 0 0 0 0 rears Credit : Other amounts paid - Ar0 0 0 0 0 0 0 rears (Educess) Cash : Other amounts paid - Ar0 0 0 0 0 0 0 rears (Educess) Credit : Other amounts paid - Ar0 0 0 0 0 0 0 rears (Sec & Higher Educess) Cash : Other amounts paid - Ar0 0 0 0 0 0 0 rears (Sec & Higher Educess) Credit : Other amounts paid - In0 0 0 0 0 0 0 terest : Other amounts paid - Pen0 0 0 0 0 0 0 alty : Section 73A Amount Paid ^ 0 0 0 0 0 0 0 : Any Other Amount (Please 0 0 0 0 0 0 0 specify) : (II) DETAILS OF CHALLAN (VIDE WHICH SERVICE TAX EDUCATION CESS, SECONDARY AND HIGHER EDUCATION CESS AND OTHER AMOUNTS PAID IN CASH) Month GAR-7 Challan Apr May Jun Jul Aug Sept 00033750405201100014 00031090306201100028 00033750507201100022 00033750308201100017 00033750309201100002 00031090410201100011

4B. SOURCE DOCUMENT DETAILS FOR ENTRIES AT COLUMN 4A(I)(a)(iii), 4A(I)(a)(iv), 4A(I)(b)(iii), 4A(I)(b)(iv), 4A(I)(c)(iii), 4A(I)(c)(iv), 4A(I)(d)(i) to (vii) Sl Entry in table Service tax,educational cess,secondary and higher education cess paid Source document No. Source Document Type Month No./ Period Date

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4C. DETAILS OF AMOUNT OF SERVICE TAX PAYABLE BUT NOT PAID AS ON THE LAST DAY OF THE PERIOD FOR WHICH RETURN IS FILED :

5. DETAILS OF INPUT STAGE CENVAT CREDIT(TO BE FILED BY A TAXABLE SERVICE PROVIDER ONLY/NOT TO BE FILLED BY SERVICE RECEIVER LIABLE TO PAY SERVICE TAX OR INPUT SERVICE DISTRIBUTOR) 5A. WHETHER THE ASSESSEE PROVIDING EXEMPTED/NON TAXABLE SERVICE OR EXEMPTED GOODS (a)Whether providing any exempted or non taxable service No (b)Whether manufacturing any exempted goods No

(c) If any one of the above is yes, whether maintaining separate account for receipt or consumption of No input service and input goods(refer to rule 6(2) of CENVAT credit Rule,2004) (d) If any one of the (a) and (b) is 'Yes' and (c) is 'No',which option is being availed under rule 6 (3) of the Cenvat Credit Rules,2004 (i) Opted to pay an amount equal to 10% of the value of exempted goods and 8% of the No value of exempted service (Y/N) or (ii) Opted to pay an amount equivalent to CENVAT Credit attributable to inputs and input No services used in or in relation to manufacture of exempted goods or provision of exempted service(Y/N)

5AA AMOUNT PAYABLE UNDER RULE 6 (3) OF THE CENVAT CREDIT RULES,2004 Sl MONTH No (a) Value of Exempted good cleared : (b) Value of exempted services provided : (c) Amount paid under rule 6(3) of Cenvat Credit Rules,2004 by CENVAT Credit : (d) Amount paid under rile 6(3) of Cenvat Credit Rules,2004 by cash : (e) Total Amount paid for Cenvat : Apr 0 0 0 May 0 0 0 June 0 0 0 July 0 0 0 Aug 0 0 0 Sept 0 0 0

(f)

Challan Nos,vide which amount mentioned in (d) is paid Month Apr May Jun Jul Aug Sept GAR-7 Challan

CREDIT DETAILS FOR SERVICE TAX PROVIDER / RECEIPIENT (A) CENVAT CREDIT DETAILS (all figures in rupees) Details of Credit Opening Balance : Credit taken on inputs : Credit taken on capital goods : Credit taken on input services received directly : Credit taken as received from input service distributor : Credit taken from inter unit transfer by a LTU : Total credit availed : Credit utilized for payment of service Apr 0 0 0 0 0 0 0 0 May 0 0 0 0 0 0 0 0 June 0 0 0 0 0 0 0 0 July 0 0 0 0 0 0 0 0 Aug 0 0 0 0 0 0 0 0 Sept 0 0 0 0 0 0 0 0 Page 7 of 9

tax : Credit utilized for payment of educational cess on taxable service : Credit utilized for payment of excise or any other duty : Credit utilized towards clearance of input goods and capital goods removed as such : Credit utilized towards inter unit transfer of LTU : Credit of education cess and secondary and higher education cess utilized for Payment under rule 6(3) of the Cenvat Credit Rules,2004 : Total credit utilized : Closing Balance of CENVAT credit : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

(B) EDUCATION CESS CREDIT DETAILS (all figures in rupees) Details of Credit Opening Balance : Credit of education cess and secondary and higher education cess taken on inputs : Credit of education cess and secondary and higher education cess taken on capital goods : Credit of education cess and secondary and higher education cess taken on input services received directly : Credit of education cess and secondary and higher education cess taken as received from input service distributor : Credit of education cess and secondary and higher education cess taken from inter unit transfer by a LTU : Total credit of education cess and secondary and higher education cess taken : Credit of education cess and secondary and higher education cess utilized for payment of education cess and secondary and higher education cess on services : Credit of education cess and secondary and higher education cess utilized for payment of education cess and secondary and higher education cess on goods : Credit of education cess and secondary and higher education cess utilized towards payment of education cess and secondary and higher education cess on clearance of input goods and capital goods removed as such : Credit of education cess and secondary and higher education cess utilized towards inter unit transfer of LTU : Total credit of education cess and secondary and higher education cess utilized : Closing Balance of Education cess and secondary and higher education cess : Apr 0 0 May 0 0 June 0 0 July 0 0 Aug 0 0 Sept 0 0

Page 8 of 9

CREDIT DETAILS FOR INPUT SERVICE DISTRIBUTOR (A) DETAILS OF CENVAT CREDIT RECEIVED AND DISTRIBUTED (all figures in rupees) Details of Credit Apr May June July Aug Sept

(B) DETAILS OF EDUCATION CESS RECEIVED AND DISTRIBUTED (all figures in rupees) Details of Credit Apr May June July Aug Sept

7. SELF-ASSESSMENT MEMORANDUM (a) I/We declare that the above particulars are in accordance with the records and books maintained by me/us and are correctly stated. (b) I/We have assessed and paid the service tax and/or availed and distributed CENVAT credit correctly as per the provisions of the Finance Act, 1994 and the rules made thereunder. (c)I/We have paid duty within the specified time limit and in case of delay, I/We have deposited the interest leviable thereon.

8. IF THE RETURN HAS BEEN PREPARED BY A SERVICE TAX RETURN PREPARER (STRP), FURNISH FURTHER DETAILS AS BELOW: (a) Identification No. of STRP : (b) Name of STRP :

Name : Place : Revised Date :

JOGALEKAR REFRACTORIES PVT. LTD. RABALE, NAVI MUMBAI Date : 18/10/2011

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