The West Bengal Sales Tax - Forms
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FORM 15A

Statement of issue of declaration forms or forms of certificate received on the previous occasion

[See rule 88 (3)]

R. C. No. of issuing Dealer ..........................	Covering Purchase of .......................... (Year)
His name and address .................................	Mention Form No. used - 11/12/13/13A/14
	(Maintain separate, pages for Form 11, Form 12, Form 13 Form 13A and Form 14)

Serial No. of declaration forms or forms of certificate issued	Date of issue			Dealer to whom form was issued		Purchaser's order, seller's bill & Challan No. & dt. in reference to which issued	Value (Rs.)	Serial Nos. of Forms lying in stock on the date of application
	DD	MM	YY	R. C. No.	Name
(1)	(2)			(3)		(4)	(5)	(6)
						Total

CERTIFIED TO BE TRUE AND CORRECT

-----------------------------------	-----------------------------------	-----------------------------------
Signature	Date	Status

* Strike out whichever is not applicable