FORM E 16

[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 TIN/SRIN...................................................under the Orissa Value Added Tax Act, 2004 and /or Identification No...................................under the

Orissa Entry Tax Act, 1999 shall be used as raw material for manufacture of the finished products to be exported out of the territory of India.