Form D-IX Form of Declaration under the Bihar Value Added Tax Act, 2005 for intra-state movement of goods [See rule 45(1)(a)] To be prepared in Triplicate - where the 'Counterfoil' is to be retained by the issuing dealer, and the 'Original' as well as the 'Duplicate' is to accompany the consignment. SL. No. ..................................... 1. Name and Address of Consignor ....................................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................................... 2. Taxpayer Identification No. of the Consignor ...................................................................................................................... 3. Name and Address of the Consignee ....................................................................................................................................................................................................................................................................................... ....................................................................................................................................................................................................................................................................................... 4. Taxpayer Identification No. of the Consignee ...................................................................................................................... 5. Place of Dispatch ..................................................................................................................................................................................................................... 6. Destination of Consignment ....................................................................................................................................................................................... 7. Name of notified Railway .......................................................................................................................................................................................... Station/Other Place, from where delivery is to be taken 8. Number and Date of: (i) Railway Receipt .......................................................................................................................................................................................... (ii) Other Document .......................................................................................................................................................................................... 9. Description of consignment: Name of Goods Value Quantity 10. Seller's Invoice/Forwarding Note No. and Date ........................................................................................................................... 11. Mode of Transport (Vehicle No.) ......................................................................................................................................................................... I/ We hereby declare that the above statements are correct and complete to the best of my/our knowledge and belief. Date ................................................ Signature of Dealer/ ..................................................................................... declared Manager ... continued -2 - RESULTS OF CHECKING ON THE ROUTE Designation and HQ of the Authority by whom the transport of the consignment was checked Description of Goods Quantity of the goods actually transported Date & Signature of the Authority mentioned at column (1) and place of checking 1 2 3 4
