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(ii) is registered with an export promotion council sponsored by
the Ministry of Commerce or the Ministry of Textiles, as the
case may be;
(iii) is a holder of Import-Export Code Number;
(iv) is registered under section 69 of the said Act;
(v) is liable to pay service tax under sub-section (2) of
section 68 of said Act, read with sub-clause (iv) or
sub-clause (v) of clause (d) of sub-rule (1) of rule 2
of the Service Tax Rules,1994, for the specified service;
1. Name of the exporter.
9 Service Tax Appeal No.50539 of 2015
2. Service Tax Registration No.
3. Division ......... Commissionerate ...............
4. Membership No. the Export Council
5. Name of the Export Council
6. Address of the registered / head office of exporter:
7. Tel. No. and e-mail ID of the exporter........:
8. Import -Export Code No..............
9. Details of Bank Account (Name of Bank, branch address
and account number)
I/we undertake that I/we shall comply with the conditions laid
down in the said notification and in case of any change in
aforementioned particulars, I/We shall intimate the same.
1. Name of the exporter.
2. Address of the registered / head office of exporter
3. Tel. No. and e-mail ID of the exporter ........
4. Service Tax Registration No. .......
5. Division ......... Commissionerate ...............
6. Membership No. Of the Export Council
7. Import Export Code No..............
8. Name of the Export Council
9. Details of Bank Account (Name of Bank, branch address
and account number)
Table-A
Details of goods exported (on which exemption of service tax availed) during the six
months ending on................................