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FORM 'N' Job No: Sir, from and landed at for the purpose of immediate exportatio from place of export per and to be consigned to (name of consignee) at (destination) be exempted from the levy of octroi. Import-Export No. Initials Of To, Number and date of Import document Number of Pkgs Description of Packages Description of Articles Import Marks If Any Weight or Quantity as per Import Document Number of Packages escorted earlier N Form No. No Pkg Number of Packages on which octroi has been paid No Pkg Imp Bill Number Of Pkgs To Be Escorted Number and Date Of Export Document Weight and value and rate for Octroi Remarks Let the above articles be removed free of Octroi to the place of export (Name and designation) I/We do hereby declare that the contents of the Signature of the Supervising inspector (Importer or his Agent or his duly constituted attorney) Date (N.B. Please turn over for the reverse side of the form) under supervision of Shri Free Of Octroi Date Registering Officer The Dy. ASSESSOR & COLLECTOR (OCTROI) We have to request that the undermentioned Articles which have been imported by me per Application are truly stated. MUMBAI, 19/02/2008 00077/S/RSR/07-08 Authorised Signatory

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FORM 'N'Job No:

Sir,

from and landed at for the purpose of immediate exportatio

from place of export per and to be consigned to (name of consignee)

at (destination) be exempted

from the levy of octroi.

Import-Export

No.

Initials Of

To,

Number anddate of Import

document

Numberof Pkgs

Description ofPackages Description of Articles Import Marks If Any

Weight orQuantity as per

Import Document

Number of Packagesescorted earlier

N Form No. No Pkg

Number of Packages onwhich octroi has been

paid

No Pkg Imp Bill

Number OfPkgs To

BeEscorted

Number andDate OfExport

Document

Weight and valueand rate for Octroi Remarks

Let the above articles be removed free of Octroi to the place of export

(Name and designation)

I/We do hereby declare that the contents of the

Signature of the Supervising inspector

(Importer or his Agent or his duly constituted attorney)Date

(N.B. Please turn over for the reverse side of the form)

under supervision of Shri

Free Of Octroi

Date

Registering Officer

The Dy. ASSESSOR & COLLECTOR (OCTROI)

We have to request that the undermentioned Articles which have been imported by me per

Application are truly stated.

MUMBAI, 19/02/200800077/S/RSR/07-08

Authorised Signatory

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