THE HARYANA VALUE ADDED TAX - FORMS
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FORM VAT- C3 (OMITTED W.E.F. 1-1-2014)

[ See Rule 19 ]

CERTIFICATE

(To be used when making purchase by Government not being a registered dealer)

(True copy to be retained by the issuing authority)

Name of issuing Department .................

(Whether State Government or Government of India)

Name and address of the office of issue________________________________________

______________________________________

(Name and complete address of the seller together with tax payer identification number)

Certified that the goods supplied by you to this office as per details given below have been purchased by the department of _________________________________ for use and consumption by the department :

Sr. No.	Commodity	Purchase Order No.	Sale Invoice No.	Date	Amount

_____	__________	________	_____________	______	__________
_____	__________	________	_____________	______	__________

Place ________	Signature ____________
Date _________	Name ______________ Status ______________