Refund Application for SAD

CUSTOM SERIES – FORM No. 102

APPLICATION FOR REFUND OF DUTY/INTEREST – PART A

To,
The Deputy Commissioner of Customs,
Refund Section, ICD - Tuglakabad,
New Delhi – 110 020.

I/We wish to lodge this claim for refund of customs duty/interest which has been paid in excess by me/us as per details given blow:

1. Import document (Bill of Entry) No. & Date

   Sr No	B/E No.	B/E Date	TR-6 date	Refund claim amount
   1	XXXXXXX	XX.XX.XX	XX.XX.XX	XXXXX
   2	XXXXXXX	XX.XX.XX	XX.XX.XX	XXXXXX
   3	XXXXXXX	XX.XX.XX	XX.XX.XX	XXXXXX
   Total				X,XX,XXX/-

2. Duty Deposit reference (TR-6 Challan)
3. Description of Goods : As Per Annexure
4. Name and Address of
   (a) Importer : M/s XXXXXXXXXXXXXXXXXXXXX,
    XXXXXXXXXXXXXXXXXXXXX
   (b) Customs House Agent : Not Applicable
   (c) Applicant : Same as in (a) above.
5. Refund Claim Under : Notification No. 102/2007-Cus. dated 14/09/2007
6. Ground of Claim : As Addl. Duty of Customs was paid at the time of Import, should be refunded, Under Notification No. 102/2007-Cus. dated 14/09/07, because on subsequent Sale VAT also paid by Importer on the said Goods.
7. Amount of Refund Claim : Rs. X,XX,XXX/-
8. Amount of Modvat Credit availed from the Addl. Duty of Customs paid and now covered by the refund claim : NIL
9. Enclosures* in support of refund claim (*Please put a tick mark (✓) against the document being enclosed) :

   (a) Letter of authorisation from the importer in case the applicant is an agent.	✓
   (b) Triplicate copy of Bill of Entry.	✓
   (c) Duty Challan as evidence of Duty payment.	✓
   (d) Signed working sheet for the amount of refund claim.	✓
   (e) Customs attested Invoice.	NOT APPLICABLE
   (f) Customs attested Packing List.	NOT APPLICABLE
   (g) Documents for establishing the applicant's eligibility to receive the refund amount in terms of the proviso to sub–Section (2) of Section 27 of the Act, including documents for the purposes of Section 28C & 28D of the Act.	NOT APPLICABLE
   (h) Contract and Purchase Order.	NOT APPLICABLE
   (i) Modvat Credit certificate from Central Excise Authorities.	NOT APPLICABLE
   (j) Order – in – Original / in revision / in Appeal / any other Order.	NOT APPLICABLE
   (k) Short delivery certificate from custodian.	NOT APPLICABLE
   (l) Short shipment certificate from Supplier.	NOT APPLICABLE
   (m) Survey Report.	NOT APPLICABLE
   (n) Insurance claim Settlement Certificate.	NOT APPLICABLE
   (o) Catalogue / Technical Write – up / Literature.	NOT APPLICABLE
   (p) Bill for Freight / Insurance / Other Charges.	NOT APPLICABLE
   (q) Certificate of origin.	NOT APPLICABLE
   (r) Any other document considered necessary in support of the claim (Specify).	CA's Certificate, VAT/CST Challan, Self Declaration, Ledger Copy, Sales Invoice.
   (s) Total number of documents enclosed.

10. Any further details deemed necessary and relevant to the refund claim. : As per our covering Letter attached to this application.
11. Whether any other refund claim filed/pending against the same Import / Export document (Bill of Entry, Shipping Bill etc.). If yes, give details. : No
12. Whether Personal Hearing required or not before the case is decided. : No
13. Whether the Duty has been paid under protest (If yes, Customs House protest Registration No.) : No

DECLARATION

I/We M/s XXXXXXXXXXXXXXXXXXXXX, hereby declare that:

1. The content of the refund claim as perform above are true and correct to the best of our information and belief.
2. The amount and the ground for which this refund claim has been filed has not been previously claimed and paid, and that
3. The Additional Customs Duty claimed as refund has not been passed on to any other person by the importer/buyer.

For M/s XXXXXXXXXXXXXXXXXXXXX,

(Authorized Signatory)
Place: Delhi

---

To,
The Deputy Commissioner of Customs,
Refund Section, ICD - Tuglakabad,
New Delhi – 110 020.

Subject: Refund claim under Notification No.- 102/2007 dated 14/09/2007

Respected Sir,

We are enclosing herewith following document pertaining for the refund claim of Rs. X,XX,XXX/- as details below:-

1. Original Bill of Entry (Importer Copy),
2. Original TR-6 Challan (Duty Payment Receipt),
3. Copy of Importer Invoice,
4. Copy of Sale Invoice,
5. Chartered Accountants Certificate,
6. Undertaking (Self-Declaration)
7. S.A.D. Refund A/c,
8. Worksheet,
9. Copy of VAT/CST Challan/Return.

Kindly acknowledge the receipt of the same.

In view of the above enclosure, please process our application and do the needful at the earliest, In case any further clarification are needed, do let us know.

For M/s XXXXXXXXXXXXXXXXXXXXX


(Signature of the Applicant)
Place: Delhi

---

Before

The Assistant Commissioner of Customs, New Delhi

Refund of Additional Duty

I/We M/s _____________________,_______________ do hereby appoint and authorized our customs consultant Mr. XXXXXXXXXXXXXXXXXXXXX, to appear on our behalf to submit and take documents to apply for and obtain copies to inspect files, records papers and documents to do other lawful act incidental in this refund matter on our behalf.

For M/s ___________________

(Signature of the Applicant)
Place: Delhi

---

Certificate

We have examined the books of accounts and other records of M/s XXXXXXXXXXXXXXXXXXXXX having its registered office at XXXXXXXXXXXXXXXXXXXXX for the Accounting Year XXXX-XX and on that basis, we certify that the company has imported the goods under the following Bill of Entries and same had been sold by the company. Wherein the special Additional duty on import has been paid and the refund under Notification No. 102/2007 dated 14.09.07 as amended is sought by M/s XXXXXXXXXXXXXXXXXXXXX

Bill of Entry No. & Date	Qty	Sales Bill No.	Date	Qty Sold	Amount of VAT Charged (Rs)	Amount of CST Charged (Rs)
1	XXXXXXX XX.XX.XXXX	XXX	XX.XX.XXXX	XX.XX	XXXXX.XX
	XXX	XX.XX.XXXX	XX.XX		XXXXX.XX
2	XXXXXXX	XXX (x10 bills)	various	XXX.XX total	XXXXX.XX each
3	XXXXXXX	XXX (x5 bills)	various	XX.XX total		XXXXX.XX each

For H. S. XXXXX & CO.
Chartered Accountants
(X. X. XXXXX)
Partner
M. No. XXXXX
New Delhi, XX XXXX XXXX

---

To,
The Assistant Commissioner of Customs,
Refund Section, ICD - Tuglakabad,
New Delhi – 110 020.

Respected Sir,

Subject: Undertaking – Refund of Additional Duty of Customs Paid

This has reference resign with the above captioned matter. In continuation to the same we would like to state here that the 4% Additional Duty of Customs amounting to Rs. X,XX,XXX/- paid by us, which is refundable from your goods office is outstanding in our books of accounts.

We further undertake that the said amount is not included in our costing and thus is not charges in our sales invoice and not passed to the buyer/or any other person as per notification No. 102/2007 dt. 14/09/2007 regarding refundable from customs.

A ledger account of the said refundable 4% Additional Duty of Customs, duly certified by Chartered Accountant is enclosed herewith for your reference.

We further state that M/s XXXXXXXXXXXXXXXXXXXXX, Chartered Accountants, is our Statutory Auditors.

In view of the above enclosure, please process our application and do the needful at the earliest. In case any further clarification are needed, do let us know.

Thanking you

Yours truly,

For XXXXXXXXXXXXXXXXXXXXX


(Signature of the Applicant)
Place: Delhi