COUNTERFOIL
   THE CENTRAL SALES TAX
                 (R & T)
            RULES, 1957
             ⁶⁷FORM 'F'

    (Form of declaration to be
    issued by the transferee)
    [See Rule 12(5)]

Serial No..................................

Name of the issuing State
.................................................
Officer of issue.........................

Date of issue.............................

Name and address of the
person to whom issued along
with his Registration
Certificate No ......................

Date from which registration
is valid ...............................
                      

To
.............................
(Transferor)

Registration Certificate No.
of the Transferor...............

Certified that the goods
transferred to me / us as
per details below have been
received and duly
accounted for.

Description of the goods
sent .............................

Quantity or weight .............

Value of the goods ............

Number and date of invoice
⁶⁸[or challan or any other
documents under which 
goods were sent.]

Name of Railway, Steamer or
Ferry Station or Air Port or
Post Office or Road
Transport Company's office
from where the goods were
despatched ........................

No. and date of Railway 
Receipt or Postal Receipt or
Goods Receipt with trip sheet
of lorry or any other documents
indicating the means of 
transport ..........................
Date on which delivery was 
taken by the transferee ..........

The above statements are 
true to the best of my knowledge
and belief.

                  (Signature)

(Name of the person 
signing the declaration)

**(Status of the person signing
the declaration in relation to
the transferee)

**(Status of the person signing
the declaration in relation to
the transferor)

Date................................

**Strike out whichever is not
applicable

                DUPLICATE
   THE CENTRAL SALES TAX
                   (R & T)
              RULES, 1957
               ⁶⁷FORM 'F'

    (Form of declaration to be
    issued by the transferee)
    [See Rule 12(5)]

Serial No..................................

Name of the issuing State
.................................................
Officer of issue.........................

Date of issue.............................

Name and address of the
person to whom issued along
with his Registration
Certificate No ......................

Date from which registration
is valid ...............................
                      

To
.............................
(Transferor)

Registration Certificate No.
of the Transferor...............

Certified that the goods
transferred to me / us as
per details below have been
received and duly
accounted for.

Description of the goods
sent .............................

Quantity or weight .............

Value of the goods ............

Number and date of invoice
⁶⁸[or challan or any other
documents under which 
goods were sent.]

Name of Railway, Steamer or
Ferry Station or Air Port or
Post Office or Road
Transport Company's office
from where the goods were
despatched ........................

No. and date of Railway 
Receipt or Postal Receipt or
Goods Receipt with trip sheet
of lorry or any other documents
indicating the means of 
transport ..........................
Date on which delivery was 
taken by the transferee ..........

The above statements are 
true to the best of my knowledge
and belief.

                  (Signature)

(Name of the person 
signing the declaration)

**(Status of the person signing
the declaration in relation to
the transferee)

**(Status of the person signing
the declaration in relation to
the transferor)

Date................................

                  ORIGINAL
       THE CENTRAL SALES TAX
                    (R & T)
                  RULES, 1957
                  ⁶⁷FORM 'F'

    (Form of declaration to be
    issued by the transferee)
    [See Rule 12(5)]

Serial No..................................

Name of the issuing State
.................................................
Officer of issue.........................

Date of issue.............................

Name and address of the
person to whom issued along
with his Registration
Certificate No ......................

Date from which registration
is valid ...............................
                      

To
.............................
(Transferor)

Registration Certificate No.
of the Transferor...............

Certified that the goods
transferred to me / us as
per details below have been
received and duly
accounted for.

Description of the goods
sent .............................

Quantity or weight .............

Value of the goods ............

Number and date of invoice
⁶⁸[or challan or any other
documents under which
goods were sent.]

Name of Railway, Steamer or
Ferry Station or Air Port or
Post Office or Road
Transport Company's office
from where the goods were
despatched ........................

No. and date of Railway
Receipt or Postal Receipt or
Goods Receipt with trip sheet
of lorry or any other documents
indicating the means of
transport ..........................
Date on which delivery was
taken by the transferee ..........

The above statements are
true to the best of my knowledge
and belief.

                  (Signature)

(Name of the person
signing the declaration)

**(Status of the person signing
the declaration in relation to
the transferee)

**(Status of the person signing
the declaration in relation to
the transferor)

Date................................

(Note: to be furnished to
the assessing authority in
accordance with the rules
framed under Section
13(4)(e)).