FORM  51

[See rule 72(3)]

Statement showing the particulars of goods transported under section 57 of  the Madhya Pradesh Vat Act, 2002

To,

The ______________________ (Designation of the officer)

___________________________ (Address)

 

 With reference to your requisition No.________________- dated_________________

I, _____________________ Proprietor/Manager/Partner/Director of Transport Company /firm/concern known as __________________ owning vehicle No._____________________ whose office is situated at _____________________(place) hereby, furnish the following particulars the goods transported.

 

(i)

Details of the vehicle with registration No.

 

(ii)

Name and address of the driver of the vehicle

 

(iii)

Full name and address with TIN (if any) under the Madhya Pradesh Vat Act, 2002 of the dealer on whose behalf the goods are consigned.

 

(iv)

Full name and address of the person actually consigning the goods if he is a person other than the dealer mentioned in (iii) above.

 

(v)

Full name and address with TIN (if any) under the Madhya Pradesh Vat Act, 2002, of the dealer on whose behalf the goods are actually consigned.

 

(vi)

Full name and address of the person taking delivery of the goods.

 

(vii)

Name and address of the person in-charge of the goods.

 

(viii)

Place (with district) from which goods dispatched.

 

(ix)

Destination (with district)

 

(x)

Description of goods

 

(xi)

Quantity or weight

 

(xii)

Value of goods

 

(xiii)

Consignor's invoice No. and date.

 

I hereby declare that what is stated above is true to the best of my knowledge and belief.

Date

Place                                                                                                                                 Signature  with designation