FORM 403

(See sub-rule (1) of rule 51)

Declaration under Section 68 of the Gujarat Value Added Tax Act. 2003
(For movement of goods within the State or goods moving outside the State)
To, The officer in charge, Check Post …………
(1) Place from which goods are dispatched Bangalore District Bangalore
(2) Place to which goods are dispatch Aehmadabad District Aehmadabad
(3) Details of goods invoice Date
_______________________________________________________________________
(4) Consignor’s details:
Name Sutures India Pvt Ltd State Karnataka
Address Plot No 13-16, Sy N 97, State VAT No. 29760864446
Kunigal 1 Phase Date
Telephone CST No.
Fax No Date
(5) Nature of Transaction
1) Inter State Sale : 2) R.R. Endorsement : 3) Depot Transfer:
4) For Job Work / Works Contract : For Job \Work yes
5) Consignment to Branch / Agent : 6) Any Other :

(6) Consignee’s Details:

Name Cure Physicare State Gujarat
Address 9-10, Spectrum Comm Center State VAT No. 24070701429
Near G.P.O, Relief Raod Date
Telephone CST No.
Fax No Date
Consigned Value /- ____________________
Sr Desc. Of Goods Commodity Code Unit Quantity Rate of Tax Value
1 Rubber Gpoves

7) Transporter’ Detail : 8) Driver’s Details :

Name V-Xpress Name
Address Bangalore Address

Owner / Partner Name: Driving Lic. No. :

License Issuing Dt :
Signature : Signature :
(9) Vehicle No _____________________ L.R. No. Date –
(10) Name of the Address of person in charge of goods
Seal Date :

Designation:
___________________________________________ _________________
For Sales Tax Department / Check post
Entry No. Date Time Reason of abnormal stoppage Result if any

Date ______________ Signature _______________ Designation _________________