The West Bengal Sales Tax - Forms
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GOVERNMENT OF WEST BENGAL			GOVERNMENT OF WEST BENGAL
FORM 11			FORM 11
Form of Declaration			Seal of
(See rule 73 and rule 78)			Issuing
COUNTERFOIL			Officer
Serial No. .........................................			Form of Declaration
To ....................................................			(See rule 73 and rule 78)
Declaration given against :-			Issued to holder of Registration
1	2		Certificate No. ..............................................
Order/ Challan/ Bill/Cash Memo Number and date	Quantity/Weight/Value of the goods involved in the transactions referred to in column 1, which fall within the provision of :-		Serial No. ....................................................... To .................................................... (Seller) ........................................................ (Address)
	Section *17(2)(a)(i)/ 17(2)(a)(ii)/ 17(2)(a)(iii)/ 17(2)(a)(iiia)	Section 17(3)(a)(ii)	Certified that the goods ordered for in my/our purchase Order No. ............................. dated ............................./purchased from you as per bill/cash memo stated below/supplied under your challan No. ............. dated .............. are for resale in West Bengal /sale referred to in section 15 in West Bengal packing of goods for resale and are covered by my/our registration certificate


			No. ............................ dated .......................
Note-- Sign against last entry			1 *Order/ Challan/ Bill/Cash Memo Number and date	2 Quantity/Weight/Value of the goods involved in the transactions referred to in column 1, which fall within the provision of :-
Date--				Section 17(2)(a)(i)/ 17(2)(a)(ii)/ 17(2)(a)(iii)/ 17(2)(a)(iiia)	Section 17(3)(a)(ii)

			Note- Sign against last entry
			Name of the purchasing dealer in full .......................... .....................................

			Signature and status of the person signing the declaration
			Date

* Strike out the words or expressions which are inapplicable