[This Declaration form can be printed in Triplicate as *Counterfoil * Duplicate * Original]

THE CENTRAL SALES TAX

(Registration & Turnover) Rules 1957
FORM "C"
FORM OF DECLARATION [See rule 12(1)]
(Seal Of issuing Authority)
Indore Circle-2

Form Serial No. M12459989

Name of Issuing State Madhya Pradesh
Office of Issue Indore Circle-2
Date of Issue 20/09/2019
Name and Address of the purchasing dealer in MAHAVIR ENTERPRISES - 138,SUBHASH MARG ,, INDORE-23430200810
full to whom issued along with the Registration
Certificate no
Date from which registration is valid 22/07/1989
To
TIN 27360702127
Name SHRI GANESH TEXTILE AND INFRASTRUCTURE PVT LTD

Address of Seller
State of Seller Maharastra
Certified that the goods ordered for in our
purchase order No
Supplied as per Bill/Cash memo/Challan No and
Date
Purchased from you as per Bill/cash
memo/Challan No and Date

Supplied under your challan no and Date

For the Purpose of (For invoice wise details please see Annexure)
and are covered by my/our registration certificate
No/dated issued under the Central Sales tax Act,
1956.

It is further certified that I/we am/are not registered under section 7 of the said Act in the State of
............................................ in which the goods covered by this Form are/will be delivered.

MAHAVIR ENTERPRISES - 138,SUBHASH MARG ,, INDORE

Name and Address of the purchasing dealer in
full

The above statements are true to the best of my knowledge and belief.
Date Signature
Name of the person signing the declaration
Status of the person signing the declaration in
relation to the dealer
Note: Counterfoil to be retained by the purchasing dealer, Duplicate to be retained by the selling
The authenticity of this form can be verified at the website https://mptax.mp.gov.in
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 (THIS FORM SHOULD BE IN TRIPLICATE AS *COUNTERFOIL,*DUPLICATE,* ORIGINAL)

Annexure (Invoice Details) (Form-C)

Issued By,
TIN 23430200810
Name MAHAVIR ENTERPRISES

138,SUBHASH MARG ,, INDORE

Address

Office of Issue Commercial Tax, Madhya Pradesh

Form Serial No and Date M12459989 , 20/09/2019
Issued To,
TIN 27360702127
Name SHRI GANESH TEXTILE AND INFRASTRUCTURE PVT LTD

Address
Sr
Invoice No Invoice Date Amount
No.
1 48 28/01/2016 238193
Total Amount Rs. 238,193.00

The above statements are true to the best of my knowledge and belief
Signature
Name of the person signing the declaration:
Status of the person signing the :
declaration in relation to the dealer

The authenticity of this form can be verified at the website https://mptax.mp.gov.in

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