FORM 49

FORM 49

[See rule 70(3)]

DECLARATION

Under section 57 of the Madhya Pradesh Vat Act, 2002.

Book No. _______________ S.No.___________ Date of issue __________

Seal of issuing authority

Name and address of the dealer to whom issued

_________________

TIN under Madhya Pradesh Vat Act, 2002

_________________

1	Name and complete address of the consignor
2	Place from which the goods dispatched.
3	Consignor's invoice No. and date *
4	Destination (including complete address)
5	Brief description of goods
6	Total quantity or total weight
7	Total value
8	(a) Name and address of the carrier (transport company or owner of the vehicle etc.) and vehicle number
8	(b) Bilty /LR No. and date

I,__________________ declare that to the best of my knowledge and belief the above statements are true and correct.

Place

Date Seal and signature of the consignor of the goods

* If more than one invoice., details be given over leaf

(To be completed in the office of the check post)

Seal

Date

Signature and designation

Date and time of arrival of the vehicle

at the check post __________

Date and time of departure of the vehicle

from the check post _______

Reasons for abnormal detention of the

vehicle at the check post ________

Overleaf details of form 49

Serial No.	Consignor's invoice No. and date	Destination (including Complete Address)	Brief description of goods	Total quantity or total weight	Total value
(1)	(2)	(3)	(4)	(5)	(6)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Place

Date

Seal and signature of the consignor of the goods