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From:

TIN: 00000000000

FirmName: I

Address:

To,The Jt. Commissioner of Commercial Tax,

. ,. '. : . .'

Divi$ion:;.1 t.

.' ."

.'

Appii~~ion For Reque~t For Statutory Forms -: .

I. In.case of Forms lost

Tax period - Quarter: 1st 0 2ndO 3rdO 4thO

Kindof Statutory Form C: 0 F 0 H 0rTT4

Year.::.0 0'00

Serial No. of the Form:

. II._ In case of Modifications in Details of Already issued Forms:

. Tax period - Quarter: 1st 0 2nd 0 3rd 0 4th 0 Year: 0000\

Kindof Statutory Form C: 0 F 0 H 0

Serial No. of the Form:

- ."

Details: As printed: As required:No. of Invoices :

TIN of Seller :.

Seller Name: . .. . .State:

Amoun.t : . .