Annexure-3

To

      The Superintendent of Central Excise,

       (Address of the Range)_____________ ________

        _____________________________

Subject: Surrender of Registration Certificate –

I/We, _________________________________ of M/s ________________________, duly authorised in this behalf by the proprietor/ firm/company declare that we do not require registration with the Central Excise and therefore hereby surrender and deposit with you the original copy of the Registration Certificate No. ________________________ issued to me on _______________ (date) in terms of the provisions of rule 9 read with notification No. ___________________ dated ___________ .

I/We further declare that duty has been paid in respect of all excisable goods manufactured and remaining in the factory, which are liable to duty.

I/We also declare that there is no government due pending against us and that there is no demand pending against us under Central Excise Act, 1944 (1 of 1944) and rule made thereunder pending as on the date of surrendering the Registration Certificate.

Signature of the Registrant or the authorised signatory

with full name, date and seal.

Acknowledgement

I hereby acknowledge receipt of “Registration Certificate No.____________________ in original. Surrender of registration shall be subject to correctness of the declaration made above.

Superintendent of Central Excise

with full name, date and seal.