Customs Rules
The Customs and Central Excise Duties Drawback Rules, 2017

ANNEXURE-I

FORM FOR CLAIM OF DRAWBACK UNDER RULE 12

		Original
		Duplicate
		Triplicate
		Quadruplicate

PART-I

Ref. Dbk.
Invoice No.
Dated:

PARTICULARS OF GOODS TO BE EXPORTED BY PARCEL POST UNDER CLAIM FOR DRAWBACK

FORM NO.

The Assistant/Deputy Commissioner of Customs (Drawback)

Foreign Post Office __________________________ .

We, ______________________ propose to export the undermentioned consignment.

Name and Address of the Consignee ____________________________________________.

S. No.	Date of Parcels	Gross Weight	Marks/No. of Pcs.	Qty.	FOB Value	Rate of Net Dbk.	Weight	Amount Rs. P.
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)

1. Certified that goods were not taken into use after the manufacture.

2. Certified that no separate claim for rebate of duty has been made or will be made to the Central Excise Authorities under rule 18 or rule 19 of Central Excise Rules, 2002 and that the Customs and Central Excise duty has been paid on the raw materials used in the manufacture of the goods. We hereby declare that the declaration made herein is true and correct.

Strike out whatever is not applicable.

Dated:	Signature
Place:	Name
	Official seal of the Exporter

Part-II

I have examined the above parcels which contain ______________detailed above. The parcels have been packed in my presence and sealed by me with lead/wax seal No. _____________ bearing the following particulars .

Date:	Signature of the officer who examined and sealed the consignment
Place:

Certified that the above noted parcels were examined, packed and sealed under my supervision.

Date:	Signature of Supdt. Of Customs/Central Excise
Place:

Part-III

Forwarded alongwith ____________ parcels to the Superintendent, foreign Post Office, New Delhi.

Postal receipt No. _________________ .

	Post Master
	Post Office

Date and Seal of Post Office

Part-IV

Inspected _______________ parcels and found the seal intact. Examined ___________ parcels where the seals were not found intact.

Pass for export
Please detain for further action
	Signature of Examiner/Inspector Post Appraising Department
Date:
Place
Seal of Office
	_________________________ (Place)

Part-V

Certified that the parcels detailed herein have been exported out of India on ___________ by___________ Air/Sea Ex. S.S. ____________. Forwarded to the Commissioner/Principal Commissioner of Customs

Date:
Place
	Signature of Superintendent Foreign Post Office