3240751084120103145743360

FORM 403
(See sub-rule (5) of rule 51)
(For goods entering into the State from outside the State)
Declaration under Section 68 of the Gujarat Value Added Tax Act, 2003
Form No. 143875273
Date: 24-MAR-2014 07:08:41 PM
To,
The officer in charge
Check post BHILAD
(1) Place to which goods are dispatched : Gujarat District : AHMEDABAD
(2) Place from which goods are dispatched : Tamilnadu District : Coimbatore
(3) Details of goods :
Sr. No. Invoice No. Invoice Date
1 2111300735 21/03/2014
(4) Consignees details :
Name SH QUEST MFG SOLUTIONS State Gujarat
Address SHED NO 11,SHRINATHJI INDUSTREAL ESTATE OPP MUNI
GRDEN,0,RAMESHWAR ESTATE VIRAT
NGAR,ODHAV,AHMEDABAD
Registration No. 24075108412
Date 07/02/2014
Telephone 9825685721 CST No. 24575108412
Fax No. Date 07/02/2014
(5) Nature of Transaction : INTERSTATE SALE
(6) Consignors details :
Name LAXMI MACHINE WORKS LTD Registration No. 33122020099
Address ARASUR COIMBATORE 641407
Date 25/05/1972
Telephone
CST No. 577250 Fax No.
Date 25/05/1972
Consigned Value Rs.2812650
Sr.
No.
Description of Goods Commodity
Code
Unit
Quantity
Unit
Measure
Rate of
Tax
Commodity
Value
Invoice No.
1 MACHINERY USED IN THE MFG.GOOD 15030 1 Nos 2 2812650 2111300735
(7) Transporters Details :
(a) Name :
(8) Vehicle No : i) ii) L.R.No. : Date :
(9) Drivers Details:
(a) Name : (b) Driving License No. : (c) License issuing State :
(d) Drivers Signature : (e) Address :
(10) Name and the address of person in charge of goods __________________________
Seal :
Place: ____________________Date: ____________________Designation: _______________________Signature: _______________________

For Commercial Tax Department/Check post
Entry No. Reason of Abnormal stoppage Result if any
Vehicle Date Time
Arrival
Depart
Date: ________________ Designation: _________________ Status: _________________