Chhattisgarh Commercial Tax Act - 1994

Sr. No.

Seal if issuing authority

Under section 45-A of the Chhattisgarh Commercial Tax Act 1994 in respect of goods being imported into or exported out of Chhattisgarh

1.

(a) Name and complete address of the consignor

(b) If consignor is a dealer of Chhattisgarh, his registration certificate No. under the Chhattisgarh Commercial Tax Act, 1994 ……………..

2

(a) Name and complete address of consignee

(b) In consignor is a dealer of Chhattisgarh, his registration certificate No. under the Chhattisgarh Commercial Tax Act, 1994

3.

Name and complete address of the person to whom goods will be delivered, if his consignee is described as “self” in the declaration

4.

Place from which goods dispatched

5.

Destination (including District)

6.

Brief description of goods

7.

Total quantity

8.

Total Weight

9.

Total Value

10

Consignor’s invoice No. and date

11

(a) Name and full address of the carrier [Transport company or owner of the vehicles]

(b) Detail of the vehicle, if any, with its number.

© Name and address of the driver of the vehicle

(d) Name and address of the person (if any) in charge of the goods.

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

Place

Date

Signature of the Consignor of the goods.

(To be completed in the office of the check post) Time of arrival of the vehicle at the check post.

Time of departure of the vehicle from the check post ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Reasons for abnormal of the vehicle at the check post.

Seal

Signature

Date

Designation