CERTIFICATE FOR AVAILING OF EXCISE DUTY EXEMPTION

Dated: XX/09/2015
TO WHOM SO EVER IT MAY CONCERN
This is to certify that ________________________________ has been allotted the following work
pertaining to the project of _______________________________________.

Sl
.
N
o.
1

Name of the
Work

Equipme
nt / Item

Nos.

Name of Agency

Factory Locations:

The above ___________are required for delivery of the water from its source to the Plant
and from there to the storage facility for industrial use/purpose, which are being
manufactured in the factory at the locations of Manufacturers indicated as above.
This Certificate is issued at the instance of ____________________for claiming exemption of
Excise Duty as per Central Excise Dept. Notification No. 03/2004, dated: 08 th January 2004,
issued by Ministry of Finance, Department of Revenue, Central Board of Excise and Customs,
New Delhi.

DISTRICT
COLLECTOR
_____ DISTRICT