FORM 3

[See Rule 7]

Declaration

I, ____________________a dealer holding TIN _____________ under the Madhya Pradesh Vat Act, 2002, hereby declare that I have paid the tax payable by me under Section 9 in respect of the goods, particulars of which are given below, supplied by way of sale in the course of execution of a works contract for ______________________________________ (herein give particulars of the work) being executed by me in whole /*in part for and on behalf of (name of the contractor)____________________________________________________________ (address)_____________________________________________________________ (TIN) _____________________ and received payment of Rs. _________________ from the contractor.

Particulars of goods supplied in the execution of the works contract.