FORM F

COUNTERFOIL		DUPLICATE		ORIGINAL
THE CENTRAL SALES TAX		THE CENTRAL SALES TAX		THE CENTRAL SALES TAX
(Registration & Turnover) RULES, 1957		(Registration & Turnover) RULES, 1957		(Registration & Turnover) RULES, 1957

FORM ‘H’¹		FORM ‘H’¹		FORM ‘H’¹

Certificate of export		Certificate of export		Certificate of export
[See rule 12(10)]		[See rule 12(10)]		[See rule 12(10)]
Sl. No.......................................		Sl. No.......................................		Sl. No.......................................
Name of Issuing State	Seal of Issuing Authority	Name of Issuing State	Seal of Issuing Authority	Name of Issuing State	Seal of Issuing Authority
Office of Issue		Office of Issue		Office of Issue
Name and complete		Name and complete		Name and complete
address of the exporter		address of the exporter		address of the exporter
Registration No. of the exporter under		Registration No. of the exporter under		Registration No. of the exporter under
the central Sales Tax Act, 1956, if any		the central Sales Tax Act, 1956, if any		the central Sales Tax Act, 1956, if any

To,		To,		To,

(Name and complete address of the seller)		(Name and complete address of the seller)		(Name and complete address of the seller)
Sales Tax registration number of the seller		Sales Tax registration number of the seller		Sales Tax registration number of the seller
(a) under the relevant State Sale Tax law.		(a) under the relevant State Sale Tax law.		(a) under the relevant State Sale Tax law.
(b) under the Central Sales Tax Act, 1956.		(b) under the Central Sales Tax Act, 1956.		(b) under the Central Sales Tax Act, 1956.

CERTIFICATE 1: - Certified that the goods (the particulars whereof have been specified in item (1) and (2) of the Second Schedule below)		CERTIFICATE 1: - Certified that the goods (the particulars whereof have been specified in item (1) and (2) of the Second Schedule below)		CERTIFICATE 1: - Certified that the goods (the particulars whereof have been specified in item (1) and (2) of the Second Schedule below)
supplied in pursuance of our purchase order No.......................................................................... ……….. Dated ...................................................................... purchased from you as per bill /cash memo /challan No............................ dated ................................ for Rs.............................. have been sold by me /us, in the course of export out of the territory of India, as per details given in item (3) to (6) of the said Schedule, and that the said goods were purchased from you by me /us after, and for the purpose of complying with, the agreement or order No..................... dated ................................................... for on relation to such export.		supplied in pursuance of our purchase order No.......................................................................... ……….. Dated ...................................................................... purchased from you as per bill /cash memo /challan No............................ dated ................................ for Rs.............................. have been sold by me /us, in the course of export out of the territory of India, as per details given in item (3) to (6) of the said Schedule, and that the said goods were purchased from you by me /us after, and for the purpose of complying with, the agreement or order No..................... dated ................................................... for on relation to such export.		supplied in pursuance of our purchase order No.......................................................................... ……….. Dated ...................................................................... purchased from you as per bill /cash memo /challan No............................ dated ................................ for Rs.............................. have been sold by me /us, in the course of export out of the territory of India, as per details given in item (3) to (6) of the said Schedule, and that the said goods were purchased from you by me /us after, and for the purpose of complying with, the agreement or order No..................... dated ................................................... for on relation to such export.
CERTIFICATE II: It is further certified that non -liability to tax under the central Sales Act, 1956 in respect of goods referred to in Certificate. I has not been claimed from any other person and that no other certificate for such non-liability has been issued to any other person in India in respect of those goods.		CERTIFICATE II: It is further certified that non -liability to tax under the central Sales Act, 1956 in respect of goods referred to in Certificate. I has not been claimed from any other person and that no other certificate for such non-liability has been issued to any other person in India in respect of those goods.		CERTIFICATE II: It is further certified that non -liability to tax under the central Sales Act, 1956 in respect of goods referred to in Certificate. I has not been claimed from any other person and that no other certificate for such non-liability has been issued to any other person in India in respect of those goods.
CERTIFICATE-III - It is further certified that in case the goods covered by this certificate are re-imported into India by me/us after their export, I/we undertake to inform the sales tax authority of the person to whom this certificate has been supplied, about the fact of such re-import within a period of one month from the date of re-import of the said goods into India.		CERTIFICATE-III - It is further certified that in case the goods covered by this certificate are re-imported into India by me/us after their export, I/we undertake to inform the sales tax authority of the person to whom this certificate has been supplied, about the fact of such re-import within a period of one month from the date of re-import of the said goods into India.		CERTIFICATE-III - It is further certified that in case the goods covered by this certificate are re-imported into India by me/us after their export, I/we undertake to inform the sales tax authority of the person to whom this certificate has been supplied, about the fact of such re-import within a period of one month from the date of re-import of the said goods into India.
The Schedule:		The Schedule:		The Schedule:
A: Particulars of goods:		A: Particulars of goods:		A: Particulars of goods:
(1) Description of goods.		(1) Description of goods.		(1) Description of goods.
(2) Quantity of goods,.		(2) Quantity of goods,.		(2) Quantity of goods,.
B: Detail of regarding goods:		B: Detail of regarding goods:		B: Detail of regarding goods:
(3) Name of airport, seaport or land customs station through which the goods have been exported.		(3) Name of airport, seaport or land customs station through which the goods have been exported.		(3) Name of airport, seaport or land customs station through which the goods have been exported.
(4) Name of the airlines / ship /railway /goods vehicle or other means of transport through which the export has been taken place.		(4) Name of the airlines / ship /railway /goods vehicle or other means of transport through which the export has been taken place.		(4) Name of the airlines / ship /railway /goods vehicle or other means of transport through which the export has been taken place.
(5) Number and date of air consignment note / bill of lading /railway receipt or goods vehicle record or postal receipt or any other document in proof of export of goods across the customs frontier of India (Certified copy of such air consignment note /bill of lading /railway receipt /goods vehicle record / postal receipt / other document to be enclosed.		(5) Number and date of air consignment note / bill of lading /railway receipt or goods vehicle record or postal receipt or any other document in proof of export of goods across the customs frontier of India (Certified copy of such air consignment note /bill of lading /railway receipt /goods vehicle record / postal receipt / other document to be enclosed.		(5) Number and date of air consignment note / bill of lading /railway receipt or goods vehicle record or postal receipt or any other document in proof of export of goods across the customs frontier of India (Certified copy of such air consignment note /bill of lading /railway receipt /goods vehicle record / postal receipt / other document to be enclosed.
(6) Description, quantity /weight and value of the goods exported under the document referred to in item (5) above.		(6) Description, quantity /weight and value of the goods exported under the document referred to in item (5) above.		(6) Description, quantity /weight and value of the goods exported under the document referred to in item (5) above.
Verification;		Verification;		Verification;
The above statements are true to the best of my knowledge and belief and nothing has been concealed therefrom.		The above statements are true to the best of my knowledge and belief and nothing has been concealed therefrom.		The above statements are true to the best of my knowledge and belief and nothing has been concealed therefrom.
Signature with date............................................		Signature with date............................................		Signature with date............................................
Name of the person signing the certificate..... ………………………………………………………………		Name of the person signing the certificate..... ………………………………………………………………		Name of the person signing the certificate..... ………………………………………………………………
Status of the person signing the certificate in relation to the exporter.		Status of the person signing the certificate in relation to the exporter.		Status of the person signing the certificate in relation to the exporter.
Note: To be retained by the exporter.		Note: To be retained by the dealer selling goods to the exporter		Note: To be furnished to the prescribed authority in accordance with the rules made by the State Government under section 13).

COUNTERFOIL

DUPLICATE

ORIGINAL