[See Rule 44(1)(a)]

Form of Declaration by a Transferee

COUNTERFOIL

(To be retained by the Transferee)

Serial No. ........................

Name of issuing dealer ........................ along with his Registration Certificate.

Name of issuing office..............................

Date of issue.................................

Seal of issuing..............................

Authority

To

........................... (transferor)

Registration Certificate No..................... of transferor ..................... Certified that goods transferred to me/us as per details below have been received and duly recorded ..................

Description of goods sent Quantity and/or weight value of goods............... No. & date of invoice or challan under which goods sent .................. Name of mode of transport with vehicle No......... no. & date of R. R. or lorry challan or any other documents indicating means of transport. Date on which delivery was taken by the transferee.

The above statements are true to the best of my knowledge & belief.

Signature

(Name of the person signing the declaration with status)

Note: to be retained by the transferee.

[See Rule 44(1)(a)]

Form of Declaration by a Transferee

DUPLICATE

(To be retained by the Transferee)

Serial No. ........................

Name of issuing dealer ........................ along with his Registration Certificate.

Name of issuing office..............................

Date of issue.................................

Seal of issuing..............................

Authority

To

........................... (transferor)

Registration Certificate No..................... of transferor ..................... Certified that goods transferred to me/us as per details below have been received and duly recorded ..................

Description of goods sent Quantity and/or weight value of goods............... No. & date of invoice or challan under which goods sent .................. Name of mode of transport with vehicle No......... no. & date of R. R. or lorry challan or any other documents indicating means of transport. Date on which delivery was taken by the transferee.

The above statements are true to the best of my knowledge & belief.

Signature

(Name of the person signing the declaration with status)

Note: to be retained by the transferee.

[See Rule 44(1)(a)]

Form of Declaration by a Transferee

ORIGINAL

(To be retained by the Transferee)

Serial No. ........................

Name of issuing dealer ........................ along with his Registration Certificate.

Name of issuing office..............................

Date of issue.................................

Seal of issuing..............................

Authority

To

........................... (transferor)

Registration Certificate No..................... of transferor ..................... Certified that goods transferred to me/us as per details below have been received and duly recorded ..................

Description of goods sent Quantity and/or weight value of goods............... No. & date of invoice or challan under which goods sent .................. Name of mode of transport with vehicle No......... no. & date of R. R. or lorry challan or any other documents indicating means of transport. Date on which delivery was taken by the transferee.

The above statements are true to the best of my knowledge & belief.

Signature

(Name of the person signing the declaration with status)

Note: to be retained by the transferee.