FORM  50

{See rule  71}

Declaration

Under section 57 of the Madhya Pradesh Vat Act, 2002 in respect of goods belonging to a person.

 

1

(a) Name and complete address of the consignor

 

 

(b) Registration  certificate  No. under  the  State Sales Tax law of  the appropriate State (if any)

 

2

Name and complete address of the consignee

 

3

Place from which the goods dispatched.

 

4

Consignor's invoice No. and date

 

5

Destination (including complete address)

 

6

Brief description of goods

 

7

Total quantity or total weight

 

8

Total value

 

9

(a) name and address of the carrier (transport       company or owner of the vehicle etc.) and       vehicle number

(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

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

 

 

 

Seal

Date

Signature and designation

 
Date and time of arrival of the vehicle a 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 ________