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25th November. 2004
Notification No. 40/2004 - Central Excise (N.T).
In exercise of the powers conferred by sub-rule (1) of rule 9A of the CENVAT Credit Rules, 2004, the Central Board of Excise
and Customs hereby specifies the following Form for the purposes of the said rule, namely, -
FORM ER-5
{sub-rule (1) of rule 9A of CENVAT Credit Rules, 2004}
1. Name of the manufacturer:
2. PAN based Registration Number:
3. Annual Declaration
(i) New declaration
(ii) Amendments to declaration already filed
(Pl. tick the appropriate box)
4. Declaration for the Financial Year ___________
Sr.
No.
Description
of principal
inputs
Central Excise
Tariff Sub-
HeadingNo. of
principal inputs
Quantity
code*
Description of finished
goods in which principal
input mentioned in
column (2) is used
Central Excise
Tariff Sub-
Heading No. of
finished goods
Quantity
code*
Quantity of principal input mentioned
in column (2) required for use in the
manufacture of unit quantity of
finished goods mentioned in column
(5)
12 3 4 5 6 7 8
*NOTE. - Please indicate the abbreviation referred to in Instruction No. 7 mentioned in Form E.R.-1 and Form E.R.-3 specified
in the Government of India, Ministry of Finance (Department of Revenue) vide No.25/2004-Central Excise (N.T.), dated the 27
th
September, 2004 published vide G.S.R.No.643 (E) dated the 25
th
September, 2004.
5. (i) I/We _________________hereby declare that the information given above is true, correct and complete in every
respect to the best of my/our knowledge and belief.
(ii) I/We am/are authorized to sign this declaration.
(Name in capital letters and signature
of the assessee or authorized signatory)
Place:
Date:
ACKNOWLEDGEMENT
Declaration for the Financial Year ___________
D D M M Y Y Y Y
Date of receipt
Place:
Date:
Name and signature of the officer with seal
F.No. 224/52/2004-CX 6
Neerav Kumar Mallick
Under Secretary to the Government of India
notifications no 40 2004 ce n t | iKargos