[TO BE PUBLISHED IN THE GAZETTE OF INDIA, EXTRAORDINARY, PART II, SECTION 3, SUB-SECTION (i)]
GOVERNMENT OF INDIA
MINISTRY OF FINANCE
DEPARTMENT OF REVENUE
Notification No. 11/2014 - Central Excise (N.T.)
New Delhi, the 28
th
February, 2014
9, Phalguna, Saka, 1935
G.S.R. (E). - In exercise of the powers conferred by sub-rule (8) of rule 9 of the CENVAT Credit Rules, 2004, and in
supersession of the notification of the Government of India, Ministry of Finance (Department of Revenue), No. 73/2003-Central
Excise (NT), dated the 15
th
September, 2003, published in the Gazette of India, Extraordinary, Part-II, Section 3, Sub-section
(i) vide number G.S.R. 746(E), dated the 15
th
September, 2003 except as respects things done or omitted to be done before
such supersession, the Central Board of Excise and Customs hereby specifies the following return Form for the purposes of
the said rule, namely: -
Quarterly return Form
(for first stage/ second stage dealer or the registered importer)
[See sub-rule (8) of rule 9]
Return for the quarter ending ......................
1.            Name of the first stage dealer/ second stage dealer/ registered importer:
2.            Excise registration number :
3.            Address :
4.            Particulars of invoices issued by the first stage dealer/ second stage dealer/ registered importer:
S.
No.
Invoice No. with
date
For the main item in the
document*
Description of the goods
Central Excise Tariff
Heading
Quantity
Amount of duty involved
(Rs.)
5.            Particulars of the documents based on which the credit is passed on :
S.
No.
Invoice/Bill of
entry No. with
date
Name and address of the manufacturer/ importer or
first stage dealer (as the case may be) #
For the main item
in the document*
Description of the
goods
Central Excise
Tariff Heading
Amount of duty
involved (Rs.)
*Give details with respect to the item with maximum duty covered by the document.
# A registered importer may indicate 'Self' in this column.
Place: Signature of the registered person
Date : or the authorized signatory
Name in capital letters
Designation
Seal of the registered dealer/importer.
2. This Notification shall come into force with effect from the 1
st
day of April, 2014.
No. 267/07/2014-CX.8
(Pankaj Jain)
Under Secretary to the Government of India