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THE WEST BENGAL VALUE ADDED TAX RULES, 2005 : FORMS
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THE WEST BENGAL VALUE ADDED TAX RULES, 2005
FORM 12A

Declaration of export of goods purchased in West Bengal

[See sub-rule (1) of rule 30C]

Seal of Issuing Officer

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

Issued to the holder of

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

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

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

Certified that for the purpose of complying with the agreement or order number......................... dated .................... with our foreign buyer, l/We made the last purchase of goods (particulars whereof are given at serial Nos .................... in the Appendix below) from you in West Bengal in pursuance of our purchase order No ............................. dated ................ for export thereof out of the territory of India under Tax Invoice/Invoice/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 Appendix below, from the seaport/airport/steamer station/customs station.................................................. (name of seaport/airport/steamer station/customs station)

and

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

and

Certified also that in the event of re-import 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, and the appropriate assessing authority of the dealer to whom this declaration is issued, about the fact of such re-import within a period of one month from the date of such re-import of the aforesaid goods.

THE APPENDIX

A: Last purchase of goods

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

(2) Quantity/weight of goods:

(3) Tax Invoice No. and date:

(4) Amount mentioned in the tax invoice:

B: Particulars of export of goods

(5) Name of airport, seaport, steamer station or land customs station through which the goods have been exported out of the territory of India:  
(6) Name of airport, seaport, steamer station or place of destination in the foreign country:  
(7) 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:  
(8) 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 of any other document in proof of export to be enclosed):  
(9) No. and date of invoice/bill drawn on the foreign buyer:  
(10) Description of the goods exported:  
(11) Quantity/weight of the goods:  
(12) Value of the goods exported as per invoice/bill (in foreign currency and the equivalent value in Indian currency):  
(13) Name of the purchasing dealer:  

    .................................................
    Signature with date
    Name and status: .................................................

Declaration of Export

(See rule 30C)

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

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

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

........................................................................................(R.C. No.)

Declaration given against-

(1) Tax invoice No. and date : :
(2) Amount mentioned in the tax invoice : :
(3) Description of goods :  
(4) Corresponding bill of lading/air consignment note/road transport consignment note/railway receipt No. and date for export :
(5) Name of the place of destination : :

  .................................................
  Signature with date
  Name and status: .................................................