GOVERNMENT OF JHARKHAND COMMERCIAL TAXES DEPARTMENT [See Rule Rule 44(1)(b)] Form of Declaration to be issued by the Principal to his Agent or Branches/Unit Serial Number: ________________________ Original/Duplicate 1. Name of the Dealer (Principal) ___________________________________ 2. Registration No. (TIN) ___________________________________ 3. Address Building Name/Number ___________________________ Area/Road ___________________________ Locality/Market ___________________________ Pin Code ___________________________ Telephone Number(s) ___________________________ 4. Name of the Agent/Branches/Units __________________________________ 5. Registration No. (TIN) ___________________________________ 6. Address Building Name/Number ___________________________ Area/Road ___________________________ Locality/Market ___________________________ Pin Code ___________________________ Telephone Number(s) ___________________________ 7. Date of dispatch of goods by the principal ____________________________ 8. Description of the goods dispatched: (Attach all challans with the dispatch note) 9. Name of the owner of the goods vehicle or other vehicle by which goods are dispatched _____________________________ 10. If the Principal is transporting the goods after purchasing them: 11. Name of the Seller ______________________________ 12. Registration No. (TIN) ______________________________ 13. Address Building Name/Number ___________________________ Area/Road ___________________________ Locality/Market ___________________________ Telephone Number(s) ___________________________ Challan No. Challan date Name of commodity Quantity/Weight Value of goods Verification I certify that the information given in this form and its attachments (if any) is true and correct to the best of my knowledge and belief and nothing has been concealed Signature Name Designation Date Place
