FORM 14

Declaration of export of goods purchased in West Bengal

(See rule 80)

Serial No................

Seal Of Issuing Officer

Issued to the holder of

Certificate of Registration No. ..................

To ........................................ (Seller)

......................................... (Address)

Certified that for the purpose of complying with the agreement or order No. ............. dated .......... with our foreign buyer I/We made for the last purchased of goods (particulars whereof are given at serial Nos. ...... of the schedule below from you in West Bengal in purchase of our purchase order No. ................. dated ............ for export thereof out of the territory of India under Cash Memo/ Bill No. ........ dated ............. for Rs. ............... (in figures) (Rupees ............) (in words).

and

Certified further that I/We have sold the aforesaid goods in the course of export out of the territory of India as per details given in the schedule below, from the seaport/airport/steamer station/ ........................

and

Certified that I/We have not claimed benefit of tax -free purchases of the aforesaid goods so exported from any other dealers and that I/We have not issued any other declaration to any other dealer in India in respect of the aforesaid goods.

and

Certified also that in the event of reimport of the aforesaid goods into India by me/us, I/We undertake to inform the appropriate assessing authority under whose jurisdiction my/our place of business falls, of the dealer to whom the declaration was issued, about the fact of such re-import within a period of one month from the date of such reimport of the aforesaid goods.

THE SCHEDULE

A : Last purchase of goods

(1) Description of goods purchased from the last selling dealer :

(2) Quantity/Weight of goods :

B : Particulars of export of goods

(3) Name of airport, seaport, steamer station or land customs station through which the goods have been exported out of the territory of India :

(4) Name of airport, seaport, steamer station or place of destination in the foreign country :

(5) Name of the airline/ship/railway/road transport or other means of transport through which the goods have been exported out of the territory of India :

(6) No. and date of air consignment note/bill of lading/steamer receipt/railway receipt/road transport consignment note/postal receipt or any other document in proof of export of the goods across the customs frontier of India (certified copy of such air consignment note/bill of lading/steamer receipt/ road transport consignment note/postal receipt or any other document in proof of export to be enclosed) :

(7) No. and date of bill/invoice drawn on the foreign buyer :

(8) Description of the goods exported :

(9) Quantity/weight of the goods :

(10) Value of the goods exported as per bill/invoice (in foreign currency and the equivalent value in Indian currency) :

(11) Name of the purchasing dealer :

Declaration of Export

(See rule 80)

Declaration given against :