FORM A-1
DECLARATION BY THE UNIT OF A SEZ OR DEVELOPER FOR AVAILING AB INITIO
EXEMPTION UNDER NOTIFICATION No._____ DATED ____
[Refer condition (d) under paragraph 2]
1. Name of the SEZ Unit/Developer:
2. Address of the SEZ Unit/Developer with Telephone and Email:
3. Permanent Account Number(PAN) of the SEZ Unit/Developer:
4. Import and Export Code Number:
5. Jurisdictional Central Excise/Service Tax Division:
6. Service Tax Registration Number/Service Tax Code:
7. Declaration: I/We hereby declare that-
(i) The information given in this application form is true, correct and complete in every respect and I am authorised to sign on behalf of the SEZ Unit/Developer;
(ii) I/We maintain proper account of specified services, as approved by the Approval Committee of SEZ, received and used for authorised operations in SEZ; I/we shall make available such accounts and related records, at all reasonable times, to the jurisdictional Central Excise Officers for inspection or scrutiny.
(iii) I/We shall use/have used specified services for authorised operations in the SEZ.
(iv)I/We declare that we do not own or carry on any business other than the operations in SEZ [where this item is not applicable, declaration may be submitted after striking out the inapplicable portion];
(v) I/We are aware that the Declaration is valid only for the purpose specified in Notification _______ dated ______ and is subject to fulfillment of conditions.
(vi)I/We intend to claim ab initio exemption from the following service provider(s) in the Domestic Tariff Area(DTA):
Signature and Name of Authorised Person with stamp
Date:
Place:
I have verified the above Declaration; it is correct
Signature, date and stamp of the Specified Officer of the SEZ (Specified Officer shall retain a copy of the verified Declaration, for the purpose of record)