| 1. | What description of goods made by you and liable to excise duty, do you (i) sell (ii) let out on hire or otherwise dispose of or (iii) use in or in connection with your business, which are made by you or on which you perform a process of manufacture applied by another (iv) person to your goods? State the approximate gross proceeds of such sales and (v) the approximate total value of such goods appropriated for letting out on hire or otherwise disposed of (vi) the approximate total annual value of such goods appropriated or applied for use in or in | (i) | ............................. |
| (ii) | ............................. |
| (iii) | ............................. |
| (iv) | Present $...........
Expected $........ |
| (v) | Present $...........
Expected $........ |
| (vi) | Present $...........
Expected $........ |
| 2. | What description of goods liable to excise duty do you buy— | Approximate annual value of such purchases |
| (i) | for use by you as material in making other goods liable to excise duty | $ ................................. |
| (ii) | for use by you as materials in making goods not liable to excise duty | $ ................................. |
| (iii) | for use by you in repairing other goods | $ ................................. |
| (iv) | for use in any other manner not mentioned above | $ ................................. |
| PARTICULARS OF PREMISES |
| 3. | Full list of premises (if different from no. 3 in Part 1) where the manufacture specified above is carried on. | ....................................... |
| I, (full name of signatory in BLOCK CAPITALS) hereby declare that the foregoing particulars and statements are true and complete and I apply for registration accordingly. | ....................................... |
| Date .......................................... | Signature .......................................... |
| Proprietor
Partner
Director
Secretary | of the business partnership or Company |