(Application for filing a claim of rebate of service tax and cess paid on taxable services exported)
Assistant Commissioner of Central Excise/Deputy Commissioner of Central Excise ..(full postal address).
I/We ..,(name of the person claiming rebate) holding service tax registration No. , located in . (address of the registered premises) hereby declare that I/We have exported service (name of the taxable service) under rule 5 of the Export of Service Rules, 2005 to (name of the country to which service has been exported), and on which service tax amounting to . (amount in rupees of service tax) and education cess amounting to . (amount in rupees of cess) has been paid.
2. I/We also declare that the payment against such service exported has already been received in India in full . (details of receipt of payment).
3. I/We request that the rebate of the taxable service exported by me/us in terms of rule 3 of the Export of Service Rules, 2005 may be granted at the earliest. The following documents are enclosed in support of this claim for rebate.
(Signature and name of the service provider or his authorised agent with date.)
Date of receipt of the rebate claim: ______________
Date of sanction of the rebate claim: ______________
Amount of rebate claimed: Rs. ______________
Amount of rebate sanctioned: Rs. ______________
If the claim is not processed within 15 days of the receipt of the claim, indicate briefly reasons for delay:
Signature of the Assistant Commissioner/ Deputy Commissioner of Central Excise.