Application for supplementary claim for drawback under Rue 15 of Customs and

Central Excise Duties Drawback Rules, 1995

(Where drawback received falls short of the rate finally fixed by the Government, Application for
supplementary claim for drawback should be made in the following form)
To
The Assistant ommissioner of ustoms!in!charge,
"rawback "epartment
We hereby make a supplementary claim for drawback of ustoms#entral $xcise which
has been less paid to us as explained herein
%& $xporter
(a) 'ame
(b) Address
(c) Telephone 'o&
(d) 'ame of learing Agent&
(& Goods exported
(a) "escription
(b) )uantity
(i) Gross
(ii) 'et
(c) *arks + 'o&
(d) "estination
(e) ,hipping -ill 'o& + "ate
.& /essel
(a) 'ame
(b) 0otation 'o&
1& "rawback already paid
(a) Amount
(b) ustoms 2ouse 0eference 'o&
(c) )uantity#/alue on which allowed
(d) 0ate at which allowed&
3& "rawback now claimed
(a) Amount
(b) )uantity#/alue on which allowed
(c) 0ate at which claimed&
4& 0eason for the supplementary claim&
5& 'o& of documents enclosed&6
DECLARA!"#
%& 7#We hereby declare that the supplementary claim of drawback is based on the ustoms and
entral $xcise "uties paid on the raw materials used in the manufacture of goods#exported the
duties so paid have not been claimed as rebate under the etrtral $xcise 0ules, %811&
(& 7#We hereby declare that the declaration made herein is true and correct&
,ignature 99999999999999999999

"esignation99999999999999999999
6:lease enclose copy of communication regarding rate of drawback determined under rule 4 or
5, any other document in support of supplementary claim, or other documents as may be
prescribed by 7 ommissioner of ustoms& :lease also enclose calculation sheet&