FORM VAT- 15 [See rule 21(1)] Declaration of Purchases within the State for Export Book No..... S.No.... Name of Office of issue Date of issue 1. COUNTER FOIL (To be retained by the dealer) 2. ORIGINAL (To be produced to assessing authority) 3. DUPLICATE (To be retained by the purchasing dealer) (Seal of the Issuing Authority) Name and complete address of the exporter ....................... ........................................... ........................................... ........................................... Registration No(TIN). (i) Rajasthan Value Added Tax Act, 2003 ............. (ii) CST Act 1956 ............. To, ................ ................ ................ Name and complete address of the seller ......................... ........................................... ........................................... ........................................... Registration No(TIN). (i) Rajasthan Value Added Tax Act, 2003 ............. (ii) CST Act 1956 ............. Certificate- I It is Certified that the goods (the particulars whereof have been specified in items (1) and (2) of the Schedule below) supplied by you in pursuance of our purchase Order No.......dated ......as per your VAT invoice no. ...... dated...for Rs......(in words) (Rupees.........) have been sold by me / us, in the course of export out of the territory of India, as per details given in items (3) to (6) of the said Schedule, and that the said goods were purchased from you by me / us after, and for the purpose of complying with, the agreement or Order No....... dated......for or in relation to such Export. Certificate II It is further certified that non-liability to tax under the Rajasthan Value Added Tax Act, 2003 or under the Central Sales Tax Act, 1956 in respect of goods referred to in Certificate I has not been claimed by any other person and that no other certificate for such non-liability has been issued to any other person in India in respect of these goods. Certificate III It is further also certified that in case the goods covered by this certificate are re imported into India by me / us after their export, I / We undertake to inform the Assessing authority or any other officer authorised by the Commissioner or the person to whom this certificate has been supplied, about the fact of such re import within a period of one month from the date of re-import of the said goods into India. Date... Signature with Status THE SCHEDULE A- Particulars of Goods 1. Description of goods ............................ 2. Quantity of goods ..... B-Details regarding Export 3. Name of airport, seaport or land customs .................... station through which the goods have been exported. 4. Name of the airlines / ship / railway / goods .................... vehicle or other means of transport through which the export has taken place. 5. Number and date of air consignment note .................... /bill of lading / railway receipt or goods vehicle or postal receipt or any other document in proof of export of goods across the customs frontier of India (certified copy of such air consignment note / bill of lading / railway receipt / goods vehicle record / postal receipt / other document to be enclosed.) 6. Description, quantity / weight and value .................... of the goods exported under the document referred to in item (5) above. Date...... Signature ................... Name of person signing the declaration Status of the person signing the declaration VERIFICATION The above declaration is true to the best of my knowledge and belief and nothing has been concealed. Place.... Signature................... Date.... Name of person signing the declaration Status of the person signing the declaration
