Form- A, Deted 10th June, 2003

Form-A

(See rule 12)

1.            Name and address of the assessee / manufacturer :

2.            PAN :

3.            Range ________Division_______________Commissionerate________________

4              Period of return : Quarter ending _______________________

5.            Details of the manufacture and removal of goods under Notification No. 49/2003-CE dated the 10th June, 2003 or Notification No. 50/2003-CE dated the 10th June, 2003 (Tick whichever is applicable):

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