FORM 49 [See rule 70(3)] DECLARATION Under section 57 of the Madhya Pradesh Vat Act, 2002 Book No. _______________ S.No.___________ Date of issue __________ Name and address of the dealer to whom issued _________________ _________________ TIN under Madhya Pradesh Vat Act, 2002 _________________ _________________ 1 Name and complete address of the consignor 2 Place from which the goods dispatched. 3 Consignor's invoice No. and date * 4 Destination (including complete address) 5 Brief description of goods 6 Total quantity or total weight 7 Total value 8 (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 * If more than one invoice., details be given over leaf (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 ________ Overleaf details of form 49 Serial No. Consignor's invoice No. and date Destination (including Complete Address) Brief description of goods Total quantity or total weight Total value (1) (2) (3) (4) (5) (6) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Place Date Seal and signature of the consignor of the goods Seal Date Signature and designation Sealofissuingauthority
