Form of declaration to be issued by the transferee

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..... Original To be furnished to the assessing authority in accordance with the rules framed under section 13(4)(e) Serial No. ............................ Name of the issuing State ....................................... Office of issue ......................................................... Date of issue .......................................... .....

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..... ................................ Number and date of invoice 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 .....

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