THE WEST BENGAL VALUE ADDED TAX RULES, 2005FORM 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)
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.
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
Declaration of Export
(See rule 30C)
Serial No...................................................
To........................................................................................(Seller)
.........................................................................................(Address)
........................................................................................(R.C. No.)
Declaration given against-