FORM E15

[See Rule 3(4)]

DECLARATION BY THE BUYING MANUFACTURER

I/We ................................ hereby declare that the goods purchased by me/us in Cash/Credit Memo/Bill No....... dated the .......... from ...... bearing the TIN/SRIN/ Identification No............................under the Orissa Value Added Tax Act, 2004 and/or Registration No........ under the Orissa Entry Tax Act, 1999 shall be used as raw material for manufacturer of the finished products, namely ..............