Service Tax - Form A1 n4n3j

Form A1 [ See paragraph 2(b) and 2(e)] Application for claiming refund of Service Tax paid under Notification No.17/09-ST., dtd 08-07-2009

To, The Deputy/ Assistant Commissioner of Central Excise -----------------------------1 2 3 4 5 6 7 8 9 1 0

Name of the Exporter hip number of the Export Council Name of the Export Council Address of the Head office of the Exporter Telephone No and email of the exporter Division and Commissioner ate Service Tax Registration Number Import Export Code number Details of Bank Details of refund claim (Separately for each shipping bill)

Sir, I/We claim refund of Rs........... (Rupees in words) under Notification No.17/09-ST. dated 07.07.09 in respect of service tax paid on services used for export of goods

(Rupees in thousands) S . N o.

Details of goods exported on which refund of service tax claimed.

Details of shipping bill/ Bill of export, etc. (2) No. Date. Date of Let export order. 1 2 3 4 5 6 7

Bill of lading or Airway bill Number.

Details of goods exported. (3) Date. Descriptio Quanti n of ty. goods exported.

Unit.

FOB value.

Form A1 [ See paragraph 2(b) and 2(e)] Application for claiming refund of Service Tax paid under Notification No.17/09-ST., dtd 08-07-2009 8

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Form A1 [ See paragraph 2(b) and 2(e)] Application for claiming refund of Service Tax paid under Notification No.17/09-ST., dtd 08-07-2009 3 6 3 7

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Form A1 [ See paragraph 2(b) and 2(e)] Application for claiming refund of Service Tax paid under Notification No.17/09-ST., dtd 08-07-2009 6 2 6 3 6 4 6 5 6 6 6 7 6 8 6 9 7 0 7 1 7 2

9. Declaration:I / We hereby declare thatDetails of specified services used for export of goods mentioned in Columns Total amount of 2 and 3. Document service tax claimed as (4) refund. s attached (6) to evidence the amount of service tax paid and establish the use of service in exports. (5) Name of Service Invoice Date. Description of Classifi Total In As a service Tax No specified cation amount of Figures. percentage provider. Registr (pl.attach service. under service of f.o.b. ation on original the tax value No. invoice). Finance paid. in shipping Act, bill. 1994.

Form A1 [ See paragraph 2(b) and 2(e)] Application for claiming refund of Service Tax paid under Notification No.17/09-ST., dtd 08-07-2009 (i) the information given in this application form is true, correct and complete in every respect and that I am authorised to sign on behalf of the exporter; (ii) no CENVAT credit of service tax paid on the specified services used for export of said goods shall be taken under the CENVAT Credit Rules, 2004; (iii) the exemption has been claimed for service tax which has been actually paid on the specified services; (iv) I / we shall maintain records pertaining to export goods and the taxable services used for export of the said goods and shall make available, at the declared premises, at all reasonable time, such records for inspection and examination by the Central Excise Officer authorised in writing by the jurisdictional Assistant Commissioner of Central Excise or the Deputy Commissioner of Central Excise, as the case may be. Date: Place: Signature and full address of Exporter (Affix stamp)