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Form of Declaration

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..... e furnished to prescribed authority Name of issuing State ........................... Office of issue .................. ..... Date of issue ....................... Name of the purchasing dealer to whom issued alongwith his Registration Certificate No. ....................................................... Date from which registration is valid ............ .....

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..... rtificate No. ........................................ dated .............. issued under the Central Sales Tax Act, 1956. ** It is further certified that I/We am/are not registered under section 7 of the said Act in the State of ... .. .. in which the goods covered by this Form are/will be delivered. Name and address of the purchasing dealer in full ...... . Date ....... .....

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