FORM - XLII

Department of Commercial Taxes, Government of Uttar Pradesh

[See rule 57(2) of UPVAT Rules, 2008]
Application for obtaining declaration for import form -other then registered dealer

To,
………………………………. (Assessing Authority)
………………………………..
Sir,
I wish to import or receive from outside the State goods of the following description and value for the
purpose of personal consumption:
1. Description of goods

2. Weight/Measure
3. Quantity
4. Value of goods in figure
5. Value of goods in word

6. Bill/cash memo/challan/tax
invoice no.*and date
7. Name & address of seller or
consigner of goods

8. TIN
I do hereby declare that the above information is correct and complete to the best of my knowledge and
belief. I further request that a certificate number XXXIX permitting the import of the above goods may kindly be
issued to me.
Annexure:
1. Proof of personal identification & address.
2. Seller’s Bill/cash memo/challan/tax invoice*
3. Any other document to the satisfaction of assessing officer.

Signature of purchaser/ consignee

Name and full address of the

Applicant

Phone No. (if any)

*Strike whichever is inapplicable.