FORM ST-39
[See rule 40-B (2)]
MONTHLY RETURN OF CLEARING, FORWARDING, TRANSPORTING ETC.
Name and address of the clearing/forwarding house/
Transporting agent etc.......................................................
The month for which the return relates.......................................
D E C L A R A T I O N
I/We ...................................................................................... Declare that to the best of my/our knowledge that the information furnished in the above return is true and correct and that it relates to the month of ...............................