FORM E-38

(To be printed in quadruplicate)

( Refer sub-rule (3(aa)) of rule 10)

CHALLAN FORM

(0042 - Entry Tax)

By whom tendered ..............................................................................................................................

Name and address of the dealer ........................................................................................................

..............................................................................................................................

Periods to which payment relates

(in words ..............................................................)

Signature of Depositor

FOR OFFICIAL USE

1. Received payment of Rs. ............................

(in words) ......................................

2. Date of entry. .........................