: TThis Deciaration form can be printed in Triplicate as “Counteroll > Duplicate * Orginal ‘THE CENTRAL SALES TAX (Registration & Turnover) Rules 1957 FORM "Cc" FORM OF DECLARATION [See rule 12(1)] Series No. + Ryfc/2013-2014 Serial No. : 000867390 Name of Issuing State + Rajasthan Seal of Issuing Authority Date of Issue O2MAR-2014 This form of Declaration is valid only for the following: (1) Period. 2 O1-JUL-2013 To 30-SEP-2013 (2) Total Number of Invoices ae (3) Total Value : Rs. 4,583,856.00 Name, Registration Certificate No. and Address of the Purchasing Dealer to whom issued : ‘SMCC CONSTRUCTION INDIA LTD - 08560702670 - NEAR MANOJ DHARAM KANTA NH 8, BEHROR, THE BEHROR, SHAHJAHANPUR , RAJASTHAN Date from which registration is valid 2 26-DEC-2007 To, ‘SCHNEIDER ELECTRIC IT BUSINESS INDIA PVT LTD - 29160072146 - Karnataka (Name, TIN and State of Selling Dealer) Certified that the goods ordered for in our Purchase Order No Refer Annexure-A of this Form dated Refer ‘Annexure-A of this Form and purchased from you/supplied as per your Bill/Cash Memo/Challan No. Refer ‘Annexure-A of this Form dated Refer Annexure-A of this Form as stated below are for resale / use in manufacture / processing of goods for sale / use in mining / use in generation / distribution of power / Packing of goods for sale / resale / use in telecommunication network and are covered by my / our registration certificate issued under the Central Sales Tax Act, 1956. 'tis further certified that Ive am/are not registered under Section 7 of the said Act in the State of Rajasthan in which the goods covered by this Form are/will be delivered. ‘The above statements are true to the best of my knowledge and belief. Name and Signature of the person signing the declaration Signature Name Date ‘Status of the person signing the declaration in relation to the dealer Paget of-—— {This Declaration form can be printed in Triplicate as *Counterfoll* Duplicate * Original] Annexure A: TRANSACTION DETAILS IN RELATION TO CST FORM-C # Particulars of BillCash Memo/ Challan: Date NO. Amounts(Rs.) Form Series No. RuIC/2013-2014 Form Serial No. 000867390 Office of Issue Commercial Taxes Department, Rajasthan Name of the purchasing dealer to whom issued ‘SMCC CONSTRUCTION INDIA LTD Registration Number (TIN) of purchasing dealer to; 08560702670 whom issued To, a) Name of the Seller SCHNEIDER ELECTRIC IT BUSINESS b) TIN of the Seller * 28180072146 ©) Name of the State of Selling Dealer ¢ Karnataka Invoice Details : 26/09/2013 2,075,000.00 2 50034537 = | 2670972013 2,508 856.00 RESALE Total Amount (in Rs.) 4,583,856.00 The above statements are true to the best of my knowledge and beliet. NOEMLYS: Signature - ‘Name of the person signing the declaration : ae i ory ‘Status of the person signing the dectaration in relation to the dealer: Hote Vert the details ofthis form through Validate CST Form’ facility avaliable on CTD Web Portal P Home Page ee ee ee Page 2 of 2