Form VAT - XX (See rule 44(2) of the Goa Value Added Tax Rules, 2005) DECLARATION (a)..... In respect of goods being imported into the State Exported out of the State (1) (a) Name and complete address of the consignor ...... (b) TIN number of the consignor............. (2) (a) Name and complete address of the consignee...... (b) TIN number of the consignee............. (3) Place from which goods dispatched............ (4) Destination ...................... (5) Description of goods ................. ........................... (6) Quantity/weight................... (7) Value of goods.................... (8) Consignor's invoice no. and date.............. (9) Mode of transport................... (10) Name and full address of the carrier (transport co. owner of the vehicle, etc).......... (11) Railway receipt/bill of lading no. and date.......... I .....declare that to the best of my knowledge and belief, the above statements are true and correct. .............. Date:..... Signature of the consignor or his authorised agent (12) In the case of transport by road, following details should be furnished by the Transport Company: (a) Details of the vehicle with its number. .................................... (b) Name and address of the driver of the vehicle. ....................................... (c) Name and full address of the person incharge of the goods .................................... I, .......being the ........declare that to the best of my knowledge and belief the above statements are true and correct. .............. (Signature or thumb impression of the driver or the person in charge of goods) (to be completed in the office of Check-Post) Name of the Check-Post............. Date and time of arrival of the Vehicle carrying the goods at Check-Post................................... Certified that I have checked the goods above mentioned. Officer in charge of the Check-Post .......... (Signature) Note: To be filled in triplicate (a) here mention the words 'original',' duplicate' and 'triplicate'
