The Central Sales Tax (Orissa) Forms
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Body

FORM - B

(To be furnished in duplicate)*

"Statement of certificate in Form EI /EII submitted for the quarter ending dt. ___/____/______

[See rule 7A of the Central Sales Tax (Orissa) Rules, 1957]

Particulars of transactions under Section 3(b) in respect of which exemption claimed under Section 6(2) of the CST Act, 1956 relating to the quarter ending on_________________

Sl. No.	Name and address of the purchasing dealer	TIN/ CST RC No. With date of validity, if any	Sale invoice No. & Date	Description of goods	Quantity/Weight	Value of goods (in Rs.)	Name and address of the selling dealer	Sl. No of Certificates in Form 'E I' 'E II'
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)	(i)
1
2
3
Total

DECLARATION

I,_____________________________ (Name in Capital), submit herewith the Form 'EI / EII' in original hereby declare that the particulars furnished above are true and correct.

(Enclosure ............ No. of Forms EI / EII)

	Full signature of the authorized signatory
Place _______________	Name ______________________________
Date _______________	Status ______________________________

ACKNOWLEDGEMENT

(Received ............... numbers of Form 'EI / EII')

	signature of the receiving officer
Place _______________	Name of the receiving officer
Date _______________

* - First Copy - To be retained by the office

Second Copy - To be handed over to the dealer"