No credit or refund of an overpayment arising by reason of a price readjustment described in § 48.6416(b)(1)-2 or § 48.6416(b)(1)-3 shall be allowed unless the manufacturer who paid the tax submits a statement, supported by sufficient available evidence—
§ 48.6416(b)(1)-4(a) Describing the circumstances which gave rise to the price readjustment,
§ 48.6416(b)(1)-4(b) Identifying the article in respect of which the price readjustment was allowed,
§ 48.6416(b)(1)-4(c) Showing the price at which the article was sold, the amount of tax paid in respect of the article, and the date on which the tax was paid,
§ 48.6416(b)(1)-4(d) Giving the name and address of the purchaser to whom the article was sold, and
§ 48.6416(b)(1)-4(e) Showing the amount repaid to the purchaser or credited to the purchaser's account.