Chhattisgarh Commercial Tax Act - 1994

FORM 15

[See rule 19 (4) (a) (vi)]

Statement showing the dispatches of tax paid goods by a principal to

an Adatiya for sale in his Adat.

I ………………………………… proprietor /manager /partner /director /Owner of the firm known as ……………………………………………… karta of family Whose principal place of business is situated at …………………………………. Post Office …………… Tehsil ……………… District ………………………… within the jurisdiction of Commercial Tax Officer of ………………………….. Circle. Hereby furnish the following statement on behalf of the said business under rule 19 of the Chhattisgarh Vanijyik Kar Niyam, 1995.

Place  …………….

Date    …………….

Signature of the dealer

I ………………………… proprietor/ partner/ manager/ director of the company/ karta of the family do hereby declare and verify that the information given above is true to the best of my knowledge and belief.

Place  …………….

Date    …………….

Signature of the dealer