THE ASSAM VALUE ADDED TAX RULES, 2005

FORM-56

[See Rule 37(1)]

CERTIFICATE OF EXPORT

(To be printed in triplicate-as original, duplicate and triplicate)

To

(Name and complete address of the seller)

Registration No. of the seller under the Assam Value Added Tax Act, 2003.

Certificate I - Certified that the goods (the particulars whereof have been specified in item (1) and (2) of the Schedule below) supplied in pursuance of our purchase order No. .......... dated .......... Purchased from you as per bill/cash memo/challan No. ................ dated ............ for Rs. .............. have been sold by me/us in the course of export out of the territory of India, as per details given in items (3) to (6) of the said Schedule, and that the said goods were purchased from you by me/us after, and for the purpose of complying with, the agreement or order No. .......... dated .............. for or in relation to such export.

Certificate II - It is further certificate that non-liability to tax under the Assam Value Added Tax Act, 2003 in respect of goods referred to in Certificate-I has not been claimed from any other person and that no other certificate for such non-liability has been issued to any other person in India in respect of those goods.

Certificate III - It is further certified that in case the goods covered by this certificate are reimported into India by me/us after their export I/We undertake to inform the State authority of the person to whom this certificate has been supplied, about the fact of such reimport within a period of one month from the date of reimport of the said goods into India.

THE SCHEDULE

A - Particulars of goods

(1) Description of goods ...........

(2) Quantity of goods ..............

B - Details regarding export

(3) Name of airport, seaport or land customs station through which the goods have been exported.

(4) Name of the airlines/ship/railway/goods vehicle or other means of transport through which the export has taken place.

(5) Number date of air consignment note/bill or leading/railway receipt or goods vehicle record or postal receipt or any other document in proof of export of goods across the customs frontier of India (Certified copy of such air consignment note/bill of leading/ railway receipt/goods vehicle record/postal receipt/ other document to be enclosed).

(6) Description, quantity/weight and value of the goods exported under the document referred to in item (5) above.

VERIFICATION

The above statements are true to the best of my knowledge and belief and nothing has been concealed therefrom.

Signature with date ......................

Name of the person signing the certificate .......................

Status of the person signing the certificate in relation to the exporter ........................