FORM XIX

(See sub-rule (2)of rule 31)

Application for Form of Certificate for Import

To,

The Assistant Commissioner Commercial Tax

Sector----------Circle----------------------------

Sir,

I,......................................................s/o.............................................................................resident of ...................................................................................................................(complete address alongwith, house no., name of road / street/ lane, mohalla, village/town, P.O. and District), hereby declare that I wish to import or receive from outside the State goods of the following description and value for the purpose of * re- sale/use in manufacture of goods for sale/ personal consumption..

I hereby declare that the above information is true to the best of my knowledge and belief.

I request that a certificate permitting the import of the above goods may kindly be issued to me.

*strike out whichever is not applicable.