FORM ST-3B

(See Rule 7A)

Return of service tax credited to the Government of India for the period commencing on and from the 16^th day of July, 1997 to the 16^th day of October, 1998, in case of service provided by goods transport operator and; clearing and forwarding agents ..................Commissionerate

1. Name of the assessee....................

2. Category of service: Goods transport operator service/clearing and forwarding agents service

3. Service tax registration No...................... (optional) (in case assessee does not have registration No.)

4. PAN No....................

5. Period*....................

6. Value of taxable service ....................

7. Amount of service tax payable....................

8. Amount of interest, if any payable....................

9. Mode of payment:

Challan Nos........................

Date of challans......................

* for goods transport operator service, the relevant period is from 16.11.1997 to 2.6.1998; and for clearing and forwarding agents, the relevant period is from 16.7.1997 to 16.10.1998

Self-Assessment Memorandum

I/we declare that the above particulars are in accordance with the records and books maintained by us and are correctly stated.

I/we have assessed and paid the service tax correctly in terms of the provisions of the Act and rules made thereunder.

I/we have paid duty within the time specified in these rules and in case of delay, I/we have deposited the interest leviable as per section 75 of the Act.

Acknowledgement