The Central Sales Tax (Orissa) Forms
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Body

FORM - D

(To be furnished in duplicate)*

"Statement of Form 'H' received for the quarter ending on Dt. ____/____/______
[See rule 7A of the Central Sales Tax (Orissa) Rules, 1957]

Particulars of transactions under Section 5 (3) of the CST Act relating to the quarter ending on _____________________

Sl. No.	Sale invoice No. & Date	Bill of lading No. and Date	Export order No. And Date of foreign buyer	Name and address of the Exporter	TIN/ CST RC No.	Description of goods	Quantity / Weight	Value of goods ( in Rs.)	Sl. No. of "H" forms received
(a)	(b)	(c)	(d)	(e)	(f)	(g)	(h)	(i)	(j)
1
2
3
Total

DECLARATION

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

(Enclosure ............ No. of Forms 'H')

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

ACKNOWLEDGEMENT

(Received ............... numbers of Form 'H')

	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