THE KERALA VALUE ADDED TAX RULES, 2005

FORM No. 43

DECLARATION

(For claiming exemption on the sale of certain goods to industrial units in SEZ)

[See Rule 12 C (2) ]

This is to certify that I/we.......... (Full address), registered dealer on the rolls of ................ (VAT office address) and an industrial unit in the Special Economic Zone, ................ (specify the name of the zone), have effected purchase of industrial input/Plant & Machinery (including components) spares, tools and consumables (other than petroleum Products covered by Fourth Schedule to the KVAT Act, 2003) in relation thereto from M/S............... (Full address of the seller with TIN) for Rs............ during the month/ Financial year........ (Specify) as per particulars furnished hereunder:

Our Unit has been recognized as 100% EOU vide Order No : ..........Dt ........... of the Development Commissioner, Special Economic Zone, .............................. (location)

We also hereby undertake to pay over to the Government the amount of tax exemption availed of by us in the event of any failure to utilise the goods for the purpose declared.