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["R"]
["APPENDIX -C1"]
["OFFICE OF THE SUPERINTENDENT OF CENTRAL EXCISE"]
[]
["Range __________________ Division ___________________"]
["Commissionerate ____________________________________"]
["C. No.              Date              Shipping Bill No.*         Date"]
[]
["1.Name of EOU",null,":"]
["2.IEC No. (of the EOU)",null,":"]
["3.Factory address",null,":"]
["4.Date of examination",null,":"]
["5.Name and designation of the examining",null,":"]
["  Officer-Inspector/EO/PO"]
["6.Name & designation of the supervision",null,":"]
["  Officer-Appraiser/Superintendent"]
["7. (a)Name of Commissionerate/Division/Range",null,":"]
["  (b)Location Code**",null,":"]
["8.Particulars of Export Invoice",null,":"]
["  (a)Export Invoice No.",null,":"]
["  (b)Total No. of packages",null,":"]
["  (c)Name and address of the consignee abroad",null,":"]
["9.(a)Is the description of the goods, the Quantity and their value as per particulars furnished in the export invoice? ",null,":Yes/No"]
["   (b)Whether sample is drawn for being forwarded to port of export?",null,":Yes/No"]
["10.(a)For Non-containerized cargo"]
["      Nos. of packages",null,":Seal Nos"]
["    (b)For Containerized cargo",null,":"]
["      Container No.               Size",null,"Seal No."]
[]
[" Signature of","Signature of","Signature of"]
["Exporter","Examiner/Inspector","Appraiser/Superintendent"]
["Name : _____________ ","Name : _____________","Name : _____________"]
["Designation : _________","Designation : _________","Designation : _________"]
["Stamp:","Stamp:","Stamp:"]
["Note:"]
[]
["1. The office supervising the examination should attest Invoice(s) and any other document accompanying this document. "]
["2. * To be filled in by the exporter before filing of this document at the time goods registration in the export shed. "]
["3. * Revised 6 digit code as assigned by the Directorate of S & I, XXYYZZ"]
["XX Commissionerate"]
["YY Division"]
["ZZ Range"]

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