[THIS FORM SHOULD BE IN TRIPLICATE AS * COUNTERFOIL * DUPLICATE * ORGINAL]

THE CENTRAL SALES TAX

(REGISTRATION AND TURNOVER) RULES, 1957
FORM -C
(FORM OF DECLARATION,See Rule 12(1))

Form Serial No 320108/IC/24848/2014

Name of issuing State KERALA
Office of issue CT OFFICE 3RD CIRCLE THIRUVANANTHAPURAM

Date of issue 07/05/2018

Name and address of the purchasing dealer 32010870925, VEE YES PEE GARMENTS, T.C. 28/931,
in full(to whom issued along with KAITHAMUKKU, TRIVANDRUM
registration Certificate No)
Date from which Registration is valid 21/04/2006
To (TIN/ CST No/ Name/ Address of seller) 33332307241 (CST:33332307241) ( sri kaaviya
garemnts, tirupur )

State of seller Tamil Nadu

Certified that goods Ordered for in our telephonic order,
purchase order
Supplied as per bill /cash memo / chalan Details attached as Annexure-A
No & date
Purchased from you as per bill/cash Details attached as Annexure-A
memo/chalan No
Supplied under your chalan No /dtd Details attached as Annexure-A
For the purpose of RESALE
Covered by my/our registration certificate No 32010870925C, 01/04/2005
/ dated issued under the Central Sales Tax
Act, 1956
Name of the person signing the s vijayakumar
declaration.
Status of person signing declaration in Propreitor
relation to the dealer.
It is further certified that (I/We am/are not registered under section 7 of the said Act
in the State of Tamil Nadu 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 (Sign) .........

Particulars of Bill/ Cash memo/ Chalan No, Date and Amount are attached as Annexure-A

Counterfoil retained by the purchasing dealer, duplicate retained by the selling dealer,

Respective Assessing Authorities and dealers can verify these details through official
website of Kerala Commercial Taxes Department (www.keralataxes.gov.in)
Signature Not Verified
Digitally signed by S Vijayakumar
Date: 2018.05.07 17:56:26 IST
Reason: Statutory form signing
Location: Kerala
 [THIS FORM SHOULD BE IN TRIPLICATE AS * COUNTERFOIL * DUPLICATE * ORGINAL]
ANNEXURE -A Invoice Details (FORM -C)

Issued By (TIN / Name / State) 32010870925, VEE YES PEE GARMENTS, T.C.
28/931, KAITHAMUKKU, TRIVANDRUM

Office of issue CT OFFICE 3RD CIRCLE THIRUVANANTHAPURAM

Issued To (TIN / Name / State) 33332307241 , Tamil Nadu
(CST:33332307241) ( sr
Form Serial No & Date 320108/IC/24848/2014 , 07/05/2018

Sl No Invoice No Invoice Date Value of Goods Tax Total

1 30 23-AUG-14 12575 0 12575
Total 12,575.00 .00 12,575.00

The above statements are true to the best of my knowledge and belief (Sign) ..........
This document is digitally signed. So manual signature is not required.

Signature Not Verified

Digitally signed by S Vijayakumar
Date: 2018.05.07 17:56:26 IST
Reason: Statutory form signing
Location: Kerala