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) Date and time of arrival of the vehicle at the 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 ________ Seal Date Signature and designation
