Annexure-21

INVOICE

ORIGINAL

DUPLICATE

TRIPLICATE

QUADRUPLICATE

Invoice of goods liable to Central Excise Duty in India transmitted under Central Excise Seal to Nepal

Invoice No. ______________ Date_____________ Range_____________ Division___________ Commissionerate _______________ from _______________ (factory/warehouse) by ___________________________ through the Border Post of._______________  (Merchant's Name) ______________________

1)      I/We hereby declare that the above-mentioned particulars are true and correctly stated and that the consignment of goods is intended for export to Nepal ______(place) and shall not be diverted en route to any other country.

Signature of exporter or his authorised agent.

Place:

Date:

(To be printed overleaf)

2)      Certified that the above-mentioned packages have been identified by me and sealed with the Central Excise seal under my supervision.

Signature and designation of the Officer of Central Excise.

Running Serial No.

Date:

(to be given in red ink and encircled by the Border Examiner)

3)      Certified that the above-mentioned consignment has been duly identified by me and has passed the Border Customs Post.

(Running Serial number of the Border Check Post

to be written in red ink prominently encircled)

Signature and designation of the Indian

Officer-in-charge of the Border Customs Postat__________.

4)      Certified that the above-mentioned consignment/packages have been duly identified by me and have been received and accounted for in Nepal.

Signature and designation

(with official seal) of Nepalese Customs Officer.

Check Post ____________