FORM I
(See Rule 6A(1) of A.P.G.S.T. Rules, 1957)
Form of Declaration for Jaggery Dealers (in Triplicate)

Book No:                                                                                              

Sl.No    :

1.      Name and address of the office of the issue.

2.      Name and address of the dealer issuing the declaration.

3.      Registration No. of the declarant and the name and address of the assessing authority.

4.      Name and address of the purchasing dealer.

5.      Registration No. of the purchasing dealer and the name and address of the assessing authority.

6.      Quantity and value of the goods under sale.

7.      Bill No. and date.

I hereby declare that the tax on the turnover covered by sale bill No. ____________________ noted in Col.(7)of this declaration has been paid /or is liable to be paid by me/or has been exempted/or is eligible to be exempted from tax at my hand by virtue of declaration in Form issued to me by R.C. No._________________________________a registered dealer  on rolls of _____________________ Assistant Commercial Tax Officer/Deputy Commercial Tax Officer/Commercial Tax Officer from whom jaggery in purchased by me.

   Signature of the purchasing dealer                                                                                     (Signature of the Declarant)