The Central Sales Tax (Orissa) Forms
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FORM IX

[See rule 24 of the Central Sales Tax (Orissa) Rules, 1957]

Challan No.

404-Sales Tax (a)-Receipt under the Central Sales Tax Act

Treasury
__________
Sub-treasury
__________
Branch of the State Bank of India
For the month / quarter ending	.......................................................................

By whom tendered	Name and address and Tax Payers' Identification Numberof the dealer on whose behalf money is paid	Payment on account of	Amount
			Rs.	P.

Rupees:	Paise
	(in words)
Date ...............................		Signature of the dealer or depositor