COUNTERFOIL

DUPLICATE

ORIGINAL

THE CENTRAL SALES TAX

(REGISTRATION AND TURNOVER)
RULES, 1957

THE CENTRAL SALES TAX

(REGISTRATION AND TURNOVER)
RULES, 1957

THE CENTRAL SALES TAX

(REGISTRATION AND TURNOVER)
RULES, 1957

[FORM C

[FORM C

[FORM C

FORM OF DECLARATION
[See rule 12(1)]

FORM OF DECLARATION
[See rule 12(1)]

FORM OF DECLARATION
[See rule 12(1)]

Name of issuing State ______________________________________

Name of issuing State ______________________________________

Name of issuing State ______________________________________

Office of issue _____________________________________________

Office of issue _____________________________________________

Office of issue _____________________________________________

Date of issue _____________________________________________

Date of issue _____________________________________________

Date of issue _____________________________________________

Name of the purchasing dealer to whom issued along with his

Registration Certificate

Name of the purchasing dealer to whom issued along with his

Registration Certificate

Name of the purchasing dealer to whom issued along with his

Registration Certificate

No _______________________________________

No _______________________________________

No _______________________________________

Date from which registration is valid ______________________

Date from which registration is valid ______________________

Date from which registration is valid ______________________

Serial No _________________________________

Serial No _________________________________

Serial No _________________________________

Seal of Issuing Authority

Seal of Issuing Authority

To

To

To

*(Seller)

*(Seller)

Certified that the goods

Certified that the goods

[**Ordered

Seal of Issuing Authority

for

in

our

purchase

Order

No.

[**Ordered

for

*(Seller)
Certified that the goods

in

our

purchase

Order

No.

[**Ordered

for

in

our

purchase

Order

No.

________________ dated ________________ and supplied as

________________ dated ________________ and supplied as

________________ dated ________________ and supplied as

per Bill/Cash memo/ 2[challan No ___________________ dated

per Bill/Cash memo/ 2[challan No ___________________ dated

per Bill/Cash memo/ 2[challan No ___________________ dated

____________________ as stated below *** purchased from you as

____________________ as stated below *** purchased from you as

____________________ as stated below *** purchased from you as

per Bill/Cash Memo/] Challan No ___________________ dated

per Bill/Cash Memo/] Challan No ___________________ dated

per Bill/Cash Memo/] Challan No ___________________ dated

_________________ as stated below*** supplied under your challan

_________________ as stated below*** supplied under your challan

_________________ as stated below*** supplied under your challan

No _______________ dated ______________ are for **

No _______________ dated ______________ are for **

No _______________ dated ______________ are for **

resale

resale

resale

use in manufacture/processing of goods for sale use in mining

use in manufacture/processing of goods for sale use in mining

use in manufacture/processing of goods for sale use in mining

use in generation/distribution of power

use in generation/distribution of power

use in generation/distribution of power

1. Ins. by S.R.O. 896, dated 23rd September, 1958 (w.e.f. 1-10-1958).

2. Ins. by G.S.R. 962 (E), dated 30th December, 1976.

packing of goods for sale/resale and are covered by m y/our

packing of goods for sale/resale and are covered by my /our

packing of goods for sale/resale and are covered by m y/our

regist ration

registr ation

r egist ration

c ertific ate

No

____ ___ __ _____ ___ _

dated

c ertificate

No

____ ___ __ _____ ___ _

dated

c ertific ate

No

____ ___ __ _____ ___ _

dated

__________________ issued under the Central Sales Tax Act, 1956.

__________________ issued under the Central Sales Tax Act, 1956.

__________________ issued under the Central Sales Tax Act, 1956.

(a) ** It is further certified that I/We am/are not registered

(a) ** It is further certified that I/We am/are not registered

(a) ** 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

under section 7 of the said act in the State of...in which the goods

under section 7 of the said act in the State of...in which the goods

covered by this Form are/will be delivered.

covered by this Form are/will be delivered.

covered by this Form are/will be delivered.

Name and address of the purchasing dealer in

Name and address of the purchasing dealer in

Name and address of the purchasing dealer in

Full
_______________________________________________________

Full
_______________________________________________________

Full
_______________________________________________________

Date ________________________________

Date ________________________________

Date ________________________________

[The above statements are true to the best my knowledge

and, belief]

[The above statements are true to the best my knowledge

and, belief]

(Signature)

[The above statements are true to the best my knowledge

and, belief]

(Signature)

(Signature)

(Name of the person signing the declaration.)

(Name of the person signing the declaration.)

(Name of the person signing the declaration.)

(Status of the person signing the declaration in relation to the

dealer)

(Status of the person signing the declaration in relation to the

dealer)

(Status of the person signing the declaration in relation to the

dealer)

[Name and address of the seller with name of the State.

[Name and address of the seller with name of the State.

[Name and address of the seller with name of the State.

** Strike out whichever is not applicable.

** Strike out whichever is not applicable.

** Strike out whichever is not applicable.

*** Particulars of Bill/Cash Memo/Challan

*** Particulars of Bill/Cash Memo/Challan

*** Particulars of Bill/Cash Memo/Challan

Date _________________________ No ________________________

Date _________________________ No ________________________

Date _________________________ No ________________________

Amount ___________________________________

Amount ___________________________________

Amount ___________________________________

(Note.To be retained by the purchasing dealer.)

(Note.To be retained by the purchasing dealer.)

(Note. To be furnished to the prescribed authority in

accordance with the rules framed under section 13 (4) (e) by the
appropriate State Government.)

1. Subs, by G.S.R. 55 (E), dated 9th February, 1973 (w.e.f. 1-4-1973).

2. Ins. by G.S.R. 26 (E), dated 1st February, 1974.