ANNEXE - 2
COUNTERFOIL COUNTERFOIL COUNTERFOIL
THE CENTRAL SALES TAX THE CENTRAL SALES TAX THE CENTRAL SALES TAX
(REGISTRATION AND TURNOVER) RULES, 1957 (REGISTRATION AND TURNOVER) RULES, 1957 (REGISTRATION AND TURNOVER) RULES, 1957
FORM I FORM I FORM I
[See rule12(11)] [See rule12(11)] [See rule12(11)]
Serial No................ Serial No................ Serial No................
Issuing Authority …………………………………………………………... Issuing Authority …………………………………………………………... Issuing Authority …………………………………………………………...
Date of Issue  …………………………………………………………………. Date of Issue  …………………………………………………………………. Date of Issue  ………………………………………………………………….
Details of the SEZ dealer, to whom issued Details of the SEZ dealer, to whom issued Details of the SEZ dealer, to whom issued
   (a)  Name and Address ……………………………………………..          …………………………...……………………………………………………………..    (a)  Name and Address ……………………………………………..          …………………………...……………………………………………………………..    (a)  Name and Address ……………………………………………..          …………………………...……………………………………………………………..
   (b)  Number and Date of Registration under Central Sales Tax Act, 1956 (74 of 1956) …………………………………    (b)  Number and Date of Registration under Central Sales Tax Act, 1956 (74 of 1956) …………………………………    (b)  Number and Date of Registration under Central Sales Tax Act, 1956 (74 of 1956) …………………………………
(c)  Number and Date of  Registration No. issued by the Development Commissioner, SEZ concerned, alongwith details of goods specified in the Certificate of  Registration ……………………………….. (c)  Number and Date of  Registration No. issued by the Development Commissioner, SEZ concerned, alongwith details of goods specified in the Certificate of  Registration ……………………………….. (c)  Number and Date of  Registration No. issued by the Development Commissioner, SEZ concerned, alongwith details of goods specified in the Certificate of  Registration ………………………………..
                                      Seal of the Issuing Authority                                                 Seal of the Issuing Authority                                                 Seal of the Issuing Authority          
To To To
………………………………………………………….. ………………………………………………………….. …………………………………………………………..
………………………………………………………….. ………………………………………………………….. …………………………………………………………..
(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)
Certified  that the goods *(ordered for in our Purchase Order No. ……. ……………………. Dated ………....………………… and supplied by you as per your Bill/ Cash Memo/ Challan) No………………….. Dated …………………………… for an amount of Rs…………………  are for the purposes specified under sub-section (6) of Section 8 of the Central Sales Tax Act, 1956. Certified  that the goods *(ordered for in our Purchase Order No. ……. ……………………. Dated ………....………………… and supplied by you as per your Bill/ Cash Memo/ Challan) No………………….. Dated …………………………… for an amount of Rs…………………  are for the purposes specified under sub-section (6) of Section 8 of the Central Sales Tax Act, 1956. Certified  that the goods *(ordered for in our Purchase Order No. ……. ……………………. Dated ………....………………… and supplied by you as per your Bill/ Cash Memo/ Challan) No………………….. Dated …………………………… for an amount of Rs…………………  are for the purposes specified under sub-section (6) of Section 8 of the Central Sales Tax Act, 1956.
The above statements are true to the best of my knowledge and belief.  The above statements are true to the best of my knowledge and belief.  The above statements are true to the best of my knowledge and belief. 
                                                                                                           (Signature)                                                                                                              (Signature)                                                                                                              (Signature)  
Name of the person signing the Declaration, on behalf of the SEZ dealer....................................................                                                                                                                                                                                                                                                   Status of the person signing the declaration in relation to SEZ Dealer …………………………………………………………... Name of the person signing the Declaration, on behalf of the SEZ dealer....................................................                                                                                                                                                                                                                                                   Status of the person signing the declaration in relation to SEZ Dealer …………………………………………………………... Name of the person signing the Declaration, on behalf of the SEZ dealer....................................................                                                                                                                                                                                                                                                   Status of the person signing the declaration in relation to SEZ Dealer …………………………………………………………...
* Strike out, whichever is not applicable. * Strike out, whichever is not applicable. * Strike out, whichever is not applicable.
(Note: To be retained by the SEZ dealer)                                      (Note: To be retained by the SEZ dealer)                                      (Note: To be retained by the SEZ dealer)