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
truncated form
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

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