Appendix I

Form No. SC (E)-1

Before the Customs and Central Excise Settlement Commission . Bench at . (Form of application for settlement of a case under Section 32E of the said Act)

1. Full Name and address of the applicant :

2. Address for communication :

3. (i) Permanent account No :

(ii) Central Excise registration No :

(iii) Status :

4. Commissioner of Central Excise having jurisdiction over the applicant :

5. Period/date of the cause/dispute in connection with which the application for settlement is made :

6. Whether monthly returns showing production, clearance and central excise duty paid were filed for the period of dispute :

7. Proceedings to which application for settlement relates, the date from which the proceedings are pending and authority before whom the proceedings are pending and authority before whom the proceedings are pending :

8. Where any appeal or application for revision has been preferred after the expiry of the period specified for filing such appeal or application for revision, as the case may be, whether such appeal or revision has been admitted :

9. Date of seizure, if any :

10. Brief facts of the case and particulars of the issues to be settled :

11. Total amount of duty involved in the dispute :

12. Additional amount of duty disclosed and accepted as payable :

Signature of the applicant


I,..........son/daughter/wife of......................residing solemnly declare that I am making this application in my capacity as.............and I am competent to verify it.

That the contents of this application are true to the best of my knowledge and belief and no information relevant to the facts of the case has been suppressed. Annexures of the documents accompanying the application are true copies of the originals and the tables showing financial transaction are correct and are duly attested by me.

Verified today of......... (mention the month and year) at......... (mention the place)


1. The application fee should be credited in a branch of the authorised bank or a branch of the State Bank of India or a branch of Reserve Bank of India and the triplicate copy of the challan sent to the Settlement Commission with the application. The Settlement Commission will not accept cheques, drafts, hundies or other negotiable instruments.

2. Please state whether individual, Hindu undivided family, company, firm, an association of persons, etc.

3. The additional amount of Central Excise duty accepted as payable referred to in item 12 of the application shall be given in Annexure to this application.

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