FORM  E5

[See sub-rule (7) of rule 10]

1. Name of the person/organisation not registered dealer.
2. Details of entry of the Scheduled goods.

   Name of the scheduled goods	Purchase value in Rs.	Date of entry to the local area	Rate of tax	Entry tax payable on the entry of the scheduled goods.
   1	2	3	4	5

    

   C. Tax Payable

   (Total of Column 5 of the table in B)

   D. Tax paid

   (with mode of payment)