Chhattisgarh Commercial Tax Act - 1994 Forms "FORM 17"

FORM 17

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

Statement showing the dispatches of goods manufacture out of Taxpaid raw material or by using tax paid incidental 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.

S. No.	Name of Principal from whom goods received	Description of goods	Quantity	Approximate Value
[1]	[2]	[3]	[4]	[5]

Place ………………..

Date ………………..

Signature

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