Form of Declaration

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....…………..... Date of issue ....................... Name of the purchasing dealer to whom issued alongwith his Registration Certificate No. ....................................................... Date from which registration is valid ...................... Seal of Issuing Authority Serial No. ……..…. To ..............................................

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................... 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 purchas....