PART A: ASSESSEE PROFILE Particulars may be furnished wherever applicable.

If the information called for is nil or not applicable the same has to be mentioned.

1.

Name of the Assessee/Registrant CERC No./ST RC No.

PAUL XAVIER AAAPX5436BST001 / AAAPX5436BST002

2.

Details of Permanent Account No. i. Not applied for PAN ii. Applied for PAN but not received number a. iii. Allotted PAN If (iii) provide the following details (a) PAN (issued by Income Tax Dept.) (b) Name of the Registrant (as appearing in PAN) : : : Service Provider : : : ----AAAPX5436B

3.

Specify whether Manufacturer/ Warehouse/ Export Oriented Unit (EOU)/ Unit within FTZs/ Manufacturers Depot/ Dealer Constitution of Business (Proprietorship/Partnership/Registered Co./Unregistered Co./Trust/Society/Others) Address of the Business Premises Telephone Numbers Fax Numbers Web/E-Mail Address

4.

Proprietorship

5.

: : : : :

266 Goodshed Street Madurai 625001

04520 2350078, 2343527

Ssi_goodshed@rediffmail.com Rent

6.

Details of property holding rights of the registrant with respect to the premises Ownership / Mortgage / Lease/ Rent Estimated investment in Land, Plant & Machinery (if owned) Address of the Head Office Name & designation of the authorized person signing the application and the authorized person(s)

7. 8. 9.

: : :

11,50,000/-

266 Goodshed Street Madurai 625001

PAUL XAVIER, Proprietor.

Residential Address and Telephone Numbers (Office/Residence)/Fax numbers/E-Mail Address 10. Details of Bank Accounts used for business transactions by the registrant(Name of the Bank, Name of the branch and Account Number) Details of registration obtained from other Government Departments Customs (BIN) DGFTs IEC Code Tamil Nadu VAT CST No. Registrar of Company (CIN) Others ( specify) 12. Details of Proprietor/Partners/CEO/ Chairman/Managing Director/Trustee/ Member/etc. (Name, Designation, Address, Telephone/Fax numbers, E-Mail Address and IT PAN number) :

19 Kaveri Street Madurai 625018 04520 2661062 UBI Madurai Main 335101010026232

11.

: : : : : : : :

----------PAUL XAVIER 19 Kaveri Street Madurai 625018 04520 2661062

PART B: GENERAL INFORMATION 1. i) Dates of last IAD Audit ii) Period covered in the audit 2 i) Dates of last CERA audit ii) Period covered in the audit : -: ---nd Date :--: ---nd Date : :

I.

PART C: DETAILS OF THE MANUFACTURED GOODS (Particulars for each commodity manufactured should be given separately) 1. Commodity description : -2. Brand Name : -3. Tariff Item : -4. Details during last three financial years Description of Goods manufactured Tariff Item ( 8 digit code) Exemption Notification Availed NIL Rate of Duty

Sl.No.

II.

Description, brand name (if any), CETH and details of exemption Notification availed (if any), of goods on which duty has not been paid (in case the assessee avails SSI benefits, the goods cleared under Nil duty should be mentioned in this part) : : : Exemption Notification No. & Date

1. Commodity description 2. Brand Name 3. Tariff Heading 4. Details during last three financial years Year Assessable Value of clearance in Rs. NIL

III Details of goods exported 1. Commodity description : 2. Brand Name : 3. Tariff Item ( 8 digit code) : 4. Details during last three financial years Rs. in Crores Year Value of export clearance Value of export clearance under bond in Rs. under claim of rebate in Rs. NIL IV Details of goods under captive consumption 1. Commodity description : -2. Tariff Item ( 8 digit code) : -3. Whether used in dutiable final product or not : Yes/No V Details of goods sent for job work during the last financial year 1. Commodity description : -2.Whether raw material as such or intermediate goods : -3. Description of raw material or intermediate goods sent : -4. CETH No. : -5. Name and addresses of job worker : -6. i) Process in brief under taken by the job worker. : -ii) Whether duty paid by the assessee : -iii) Whether duty paid by the job worker : -iv) Whether waste cleared by job worker on payment of duty or returned to assessee. : Duty Paid / Returned v) Whether any capital goods, moulds, dies etc. supplier to job worker : Yes / No. VI. Details of goods received for job work during the last financial year 1. Commodity description : -2.Whether raw material as such or intermediate goods : -3. Description of raw material or intermediate goods received : --

4. CETI No. ( 8 digit code) 5. Name and addresses of sender of the raw material 6. i) Process in brief under taken ii) Whether duty paid by the assessee iii) Whether duty paid by the sender iv) Whether waste cleared by assessee on payment of duty or returned to sender. v) Whether any capital goods, moulds, dies etc. received from the sender

: -: : -: -: -: Duty paid/Returned : Yes/No

PART C TYPE OF VALUATION TO WHICH GOODS ARE SUBJECTED TO (For each commodity) (Note: In column for type of valuation, write 01 for valuation under transaction value, 02 for valuation under Valuation Rules, 03 for valuation under Tariff Value and 04 for valuation under MRP based valuation) 1. Commodity description : -2. CETI No. ( 8 digit code) : -3. Type of valuation : -PART D MARKETING PATTERNS (For each commodity) (Note: In column for nature of sale, write 01 for factory gate sale, 02 for sale through depot, 03 for sale through branch office, 04 for sale through distributor, 05 for sale through consignment agent, 06 for sale through other marketing intermediary, 07 for sale in retail, 08 for inter unit transfer, 09 for captive consumption, 10 for sale to related person. In case a commodity sold through more than on of the above categories, each type of sale of a commodity should be treated as separate commodity and mentioned individually) 1. Commodity description : -2. CETI No. ( 8 digit code) : -3. Nature of sale : -PART E DETAILS OF THE TRADED GOODS DURING THE LAST THREE FINANCIAL YEARS. (for each commodity) Commodity Year Brand Name CETI No. Sale value in Rs. NIL PART F DETAILS OF THE SERVICES RENDERED DURING THE LAST FINANCIAL YEAR. (For each service) 1. Description of service : CTC 2. Value of service : 2008-09(2472408/-) 2009-10( 2501374/-) 2010-11 (2534994/-) 3. Whether taxable service : Yes. PART G DETAILS OF THE PRINCIPAL RAW MATERIALS CONSUMED DURING LAST THREE YEARS. (Commodity wise) Commodity Year Brand CETH No. Applicable Whether Cenvat Quantum of name rate of duty availed? purchase NIL

PART H DETAILS OF MAJOR CAPITAL GOODS PURCHASED DURING LAST THREE YEARS (Give details of individual capital goods, duty/credit of which is above rupees 5 lakhs). Name of the Year of CETIH No. Amount of duty paid by Whether Cenvat Capital goods purchase the manufacturer credit being availed NIL PART I DETAILS OF PRODUCTION AND CLEARANCE DURING LAST THREE FINANCIAL YEARS. Commodity/year Production Clearance for Clearance for Clearance for Clearance for (indicate the financial (MT) home home consump- Export on Export without year starting with the consumption on tion without payment payment of duty last completed duty payment duty payment of duty financial year) Qty Value Qty Value Qty Value Qty Value Qty Value NIL PART J DETAILS OF PRINCIPAL RAW MATERIALS/INPUTS RECEIVED AND CONSUMED DURING LAST THREE FINANCIAL YEARS. Commodity/year (indicate the financial year Goods received Goods consumed starting with the current financial year) Qty Value Qty Value NIL

PART K
DETAILS OF DUTY PAYMENT DURING THE LAST THREE YEARS Year (indicate the financial years Capital Total duty paid Input Total duty starting with the PLA goods through Cenvat credit paid current financial credit credit. year) a b c (b+c) (a+b+c) 2008-09 300789 ----300789 2009-10 257638 ---257638 2010-11 261102 ----261102 Percentage of Cenvat to the total duty {(b+c)/(a+b+c)}% ----

PART L
DETAILS OF THE ANTI EVASION CASES BOOKED DURING THE LAST THREE FINANCIAL YEARS AND CURRENT FINANCIAL YEAR.

Sl. No.

Period of demand

Duty involved SCN No. & Date NIL PART M

Issue(s) involved

DETAILS OF THE AUDIT OBJECTIONS RAISED DURING LAST THREE FINANCIAL YEARS.

Sl. No.

Period of demand

Duty involved SCN No. & Date NIL

Issue(s) involved

PART N
DETAILS OF UNCONFIRMED DEMANDS

Sl. No.

SCN No. & Date

Amount of duty involved

Adjudicating authority NIL PART O

Period of pendency in months

Reasons for pendency

DETAILS OF ARREARS OF REVENUE.

S. No.

SCN No. & Date

O-I-O No. & Date

Amount of duty+RF+PP = Total outstanding dues

Outstanding amount not immediately recoverable due to Stay etc. NIL PART P

Recoverable outstanding dues

Reasons for non payment/non recovery of dues

DETAILS OF LITIGATIONS (ADJUDICATION, APPEALS, COURT CASES ETC) PENDING.

S. No.

Issue in brief

Duty + RF + PP = Forum before Total amount whom it is involved pending NIL

Period of pendency before the present deciding authority