FORM N-14

(See Rule 21)

Serial No. ___________________
Declaration by an Authorised Dealer purchasing goods for the purpose referred to in *[Clause
(3) of section 11] of the Bom-bay Sales Tax
Act, 1959.

I ______________________________________________________________
Proprietor/Guardian of ___________________________________________________
(Name of the business) I ___________________ (Name)* _______________________
of Messrs ______________________________________________________________ (Address)
______________________________________________________________
do certify that I/the said ____________________________________ am/is a registered dealer holding
certificate of registration No. __________________________________
dated ________________ and an Authorisation under section 24 of the Bom-bay Sales Tax Act, 1959, bearing
No. ___________ dated ___________ and that the goods2 [(other than the goods used for the packing of
goods manu-factured by me)] specified in Bill/Invoice No. ___________ dated ___________
of Messrs. ____________________________________________________________

i) are purchased by me/the said _____________________ for resale in the course of inter-State
trade or commerce or in the course of export out of the territory of India and such goods will be
resold by me/the said ________________ or by another authorised dealer to whom I/the said
_______________ sell/sells the goods/, within 9 months from the date of such purchases or,

ii) are purchased by me/the said ____________ for packing of the goods meant for resale in the
course of inter-state trade or com-merce or in the course of export out of the territory of India and
that such goods will be so used by me/the said _____________

sell/sells the goods within 9 months from the date of such pur-chase and that the goods so packed
will be resold by me/the said
__________________ or by the said authorised dealer in the course of inter-state trade or
commerce or in the course of export out of the territory of India within 9 months from the date of
aforesaid purchase.

I further certify that the said Authorisation was in force on the date of the aforesaid purchase.

Place _____________________ Signature _____________________

Date ______________________ Status ________________________