FORM VAT-65 [See rule 68(K)] COUNTER FOIL Circle____________ Serial A.No. (Seal of issuing Authority) Date of issue Name & address of regd. Dealer to whom issued. _____________________ TIN .:___________________ Valid w.e.f. ___________________ I,________________________________________ (proprietor/partner) (Full Name) Karta of Joint Hindu Family/Managing Director or Director authorised by the Board of Directors of the Limited company/President or Secretary of the Society , Club, or Association/Head of the office or Officer duly authorized by the Head of the Office of The _________________________Department of The Government of __________________________ Principal Officer or officer duly authorized by the Principal officer of the Authority or the Body Carrying on business under the name and style of Sarvasri_________________________________ the principal place of business whereof is situated at hereby {Complete address} Declare that the goods of the description mentioned Below are being imported by our firm Discription _______________________Qty._______ Purchase from M/s.___________________________ Against bill/cash memo/challan No.________ dated ______for Rs._______(enclosed with the duplicate copy of this declaration No. of form "C" if issued I do hereby declare that the information given above is true and correct to the best of my knowledge and belief . Date: Signature Place Status Name & full address Name & full address of Of selling dealer or the Purchasing Dealer consignor with TIN or consignee with TIN FORM VAT-65 [See rule 68(K)] COUNTER FOIL Circle____________ Serial A.No. (Seal of issuing Authority) Date of issue Name & address of regd. Dealer to whom issued. _____________________ TIN .:___________________ Valid w.e.f. ___________________ I,________________________________________ (proprietor/partner) (Full Name) Karta of Joint Hindu Family/Managing Director or Director authorised by the Board of Directors of the Limited company/President or Secretary of the Society , Club, or Association/Head of the office or Officer duly authorized by the Head of the Office of The _________________________Department of The Government of __________________________ Principal Officer or officer duly authorized by the Principal officer of the Authority or the Body Carrying on business under the name and style of Sarvasri_________________________________ the principal place of business whereof is situated at hereby {Complete address} Declare that the goods of the description mentioned Below are being imported by our firm Discription_______________________Qty._______ Purchase from M/s.___________________________ Against bill/cash memo/challan No.________ dated ______for Rs._______(enclosed with the duplicate copy of this declaration No. of form "C" if issued I do hereby declare that the information given above is true and correct to the best of my knowledge and belief . Date: Signature Place Status Name & full address Name & full address of Of selling dealer or the Purchasing Dealer Consignor with TIN or consignee.with TIN FORM VAT-65 [See rule 68(K)] COUNTER FOIL Circle____________ Serial A.No. (Seal of issuing Authority) Date of issue Name & address of regd. Dealer to whom issued. _____________________ TIN .:___________________ Valid w.e.f. ___________________ I,________________________________________ (proprietor/partner) (Full Name) Karta of Joint Hindu Family/Managing Director or Director authorised by the Board of Directors of the Limited company/President or Secretary of the Society , Club, or Association/Head of the office or Officer duly authorized by the Head of the Office of The _________________________Department of The Government of __________________________ Principal Officer or officer duly authorized by the Principal officer of the Authority or the Body Carrying on business under the name and style of Sarvasri_________________________________ the principal place of business whereof is situated at hereby {Complete address} Declare that the goods of the description mentioned Below are being imported by our firm Discription_______________________Qty._______ Purchase from M/s.___________________________ Against bill/cash memo/challan No.________ dated ______for Rs._______(enclosed with the duplicate copy of this declaration No. of form "C" if issued I do hereby declare that the information given above is true and correct to the best of my knowledge and belief . Date: Signature Place Status Name & full address Name & full address of Of selling dealer or the Purchasing Dealer Consignor with TIN or consignee with TIN Strike out whichever is not applicable. Strike out whichever is not applicable. Strike out whichever is not applicable.
