Government of Andhra Pradesh

C.T.DEPARTMENT
(Self Printed CST e-Way Bill)

FORM OF WAY BILL FORM X or FORM 600

{See Rules 33(1)(d) & 55(1)&(4)}
Ve Ve Ve Ve Ve
h h h h h
CS icle - CST
ORIGINAL
CS icle CS icle CS ic: le371706281690999CS icle
Way Bill No.
/V / / / /
28 T3-7NELLORE
DIVISION es 28 T37 Ves 28 T37 Ves 28 T(NAYUDUPETA)
CIRCLE : GUDUR 37 Ves 28 T37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
01 28:1CTD-ON
1. Office of2Issue o.
:
LINE SERVICE 20 28 o.
1 1 :
20 28 2.
1 1
o. Date of Issue : 28
:
20Jun282017
1 1
o. 09:45:02
:
20 28
17
3. Name and address 7 69 ofTthe N Dealer to whom 69 Tissued
7 Waybill N by the CTD7 : 69 TN 7 69 TN
0 0 1 09 0 1 09 0 1 09 0 1 0
Name : SAINT 9GOBAIN :4 99 INDIA 8A PRIVATE LIMITED :4 99 8A :4 99 8A :4 99 8A
Address : PLOT NO 9 J8INDUSTRIAL AREA,KARUR
5: 98,APIIC 5: 9 J8 VILLAGE,TADA,ANDHRA 5: 9 J8PRADESH,NELLORE,524401 5: 9 J8
02 38 02 38 02 38 02 38
TIN : 37370213873
Ve Ve 2 Ve 2 2
STATE : ANDHRA PRADESH
Ve Ve 2
4. Placeh From which consigned : AZHAGAPPASAMUDRAM
h h h
To which consigned : TADA h
CS icle CS icle CS icle CS icle CS icle
T3 /CONSIGNOR
5. IF THE V T /Ve THE GOODS2 : To
IS TRANSPORTING T3the/VBranch 28 T37 Ves
/
28 T37 Ves
/
(a) 2
In8pursuance 8 37to1 the
71 eofsssale for purpose of2delivery sbuyer ; or 8 7 es
(b) AfterJu 70 ethem;
purchasing
l or Ju 70 sel Ju 170 sel Ju 170 sel Ju 170 se
n of the Noor godown to an agentn for 6sale; N n 6 N n 6 N n 6
(c) From one
20 62shops
8 . 20 28 o. 20 28 o. 20 28 o. 20 28
(d) From shop or1godown 1 to:another shop or godown 1 1
for purpose : of storage or sale; or 1 1 : 1 1 : 17
TN them on his behalf
69 purchased
7 having 7 ; or69 TN 7 69 TN 7 69 TN
CST371706281690999

(e) To his principal,

09 0 1 09 0 1 09 0 1 09 0 1 0
(f) To his agent for sale :on
4 99 8A basis.
consignment :4 99 8A :4 99 8A :4 99 8A
(Mark whichever is applicable)5: 9 J8 5: 9 J8 5: 9 J8 5: 9 J8
02 38 02 38 02 38 02 38
Name and address of the Other Dealer/Person
Ve Ve 2 to whom the Goods
Ve 2 are Consigned or from whom
V(Buyer2 Goods were Purchased
V 2:
hi : SAINTGOBAIN INDIA PRIVATE hi hi eh or self or Agent or Principal) eh
C
Name cle C cle LTD C cle C icl
TIN : 33511662391 C icl
S /V: SAINTGOBAIN INDIATPRIVATE S /V S /V S e /V S e/
T
Address
28 37 es 28 37 es
LTD AZHAGAPPASAMUDRAM T
28 37 es T
28 37 es T
28 37 Ves
Ju 170 sQuantity
6. Description, el and ValueJofu
17 Goods
the
0
se
l Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
20 28 o. Commodity20 28 o. 20 2Invoice
8 o. No./Date Quantity 20 28 o.Value (Rs.) 20 28
1 1 : 1 1 : 1 1 : 1 1 : 17
7 69 Tsand
neyveli screened N 7 69 TN 7 69 TN / 27-06- 27520.00
1500003852 7 69 TN40,729.00
09 0 1 09 0 1 09 020171 00 KGS09 0 0
:4 99 8A :4 99 8A :4 99 8A : 4 99 18A
5: 9 J8 5: 9 J8 5: 9 J8 TOTAL 5
:0 9 J83
40,729.00
02 38 02 38 02 38 2
2 2 goods are consignedV: 2 82
7. VName of the Owner of the goods V vehicle or vessel by which V the V
eh eh eh eh eh
C icl C icl C icl C icl C icl
e/
TypeSof Transportation S
: Otherthan e/ Transporter Name : SSKMINES e/ Vehicle/VesselS No.e/ : TN18AJ8382 S e/
T
28 37 es
Parcel V
Service T
28 37 es V T
28 37 es V T
28 37 es V T
28 37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 : We n 6 of my/our n particulars n 6trueNand correct. n 6
DECLARATION
20 28 No.certify that to the2best 0 28 No. knowledge the 20 628 No. furnished here2are 0 28 o. 20 28
17 16 : T 17 16 : T 17 16 : T 17 16 : T 17
09 0 19 N 09 0 1 9 N 9
09 0 1 N 9
09 0 1 N 0
:4 99 8A :4 99 8A :4 99 8A :4 99 8A
5: 9 J8 5: 9 J8 5 9 J8 5 9 J
02 38 02 38 Signature of:0the 2 Dealer3to 82
whom Waybill:0issued by83the CTD
2 8
Ve Ve 2 Ve 2 Ve Ve 2
h h h h h
CS icle CS icle CS icle CS icle CS icle
/ / / / /
28 T37 Ves 28 T37 Ves 28 T37 Ves 28 T37 Ves 28 T37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
20 28 o. 20 28 o. 20 28 o. 20 28 o. 20 28
17 16 : T 17 16 : T 17 16 : T 17 16 : T 17
09 0 19 N 09 0 1 9 N 9
09 0 1 N 9
09 0 1 N 0
:4 99 8A :4 99 8A :4 99 8A :4 99 8A
5: 9 J8 5: 9 J8 5: 9 J8 5: 9 J8
02 38 02 38 02 38 02 38
2 2 2 2
CST371706281690999
 Government of Andhra Pradesh
C.T.DEPARTMENT
(Self Printed CST e-Way Bill)

FORM OF WAY BILL FORM X or FORM 600

{See Rules 33(1)(d) & 55(1)&(4)}
Ve Ve Ve Ve Ve
h h h h h
CS icle - CST
DUPLICATE
CS icle CS icle CS ic: le371706281690999CS icle
Way Bill No.
/V / / / /
28 T3-7NELLORE
DIVISION es 28 T37 Ves 28 T37 Ves 28 T(NAYUDUPETA)
CIRCLE : GUDUR 37 Ves 28 T37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
01 28:1CTD-ON
1. Office of2Issue o.
:
LINE SERVICE 20 28 o.
1 1 :
20 28 2.
1 1
o. Date of Issue : 28
:
20Jun282017
1 1
o. 09:45:02
:
20 28
17
3. Name and address 7 69 ofTthe N Dealer to whom 69 Tissued
7 Waybill N by the CTD7 : 69 TN 7 69 TN
0 0 1 09 0 1 09 0 1 09 0 1 0
Name : SAINT 9GOBAIN :4 99 INDIA 8A PRIVATE LIMITED :4 99 8A :4 99 8A :4 99 8A
Address : PLOT NO 9 J8INDUSTRIAL AREA,KARUR
5: 98,APIIC 5: 9 J8 VILLAGE,TADA,ANDHRA 5: 9 J8PRADESH,NELLORE,524401 5: 9 J8
02 38 02 38 02 38 02 38
TIN : 37370213873
Ve Ve 2 Ve 2 2
STATE : ANDHRA PRADESH
Ve Ve 2
4. Placeh From which consigned : AZHAGAPPASAMUDRAM
h h h
To which consigned : TADA h
CS icle CS icle CS icle CS icle CS icle
T3 /CONSIGNOR
5. IF THE V T /Ve THE GOODS2 : To
IS TRANSPORTING T3the/VBranch 28 T37 Ves
/
28 T37 Ves
/
(a) 2
In8pursuance 8 37to1 the
71 eofsssale for purpose of2delivery sbuyer ; or 8 7 es
(b) AfterJu 70 ethem;
purchasing
l or Ju 70 sel Ju 170 sel Ju 170 sel Ju 170 se
n of the Noor godown to an agentn for 6sale; N n 6 N n 6 N n 6
(c) From one
20 62shops
8 . 20 28 o. 20 28 o. 20 28 o. 20 28
(d) From shop or1godown 1 to:another shop or godown 1 1
for purpose : of storage or sale; or 1 1 : 1 1 : 17
TN them on his behalf
69 purchased
7 having 7 ; or69 TN 7 69 TN 7 69 TN
CST371706281690999

(e) To his principal,

09 0 1 09 0 1 09 0 1 09 0 1 0
(f) To his agent for sale :on
4 99 8A basis.
consignment :4 99 8A :4 99 8A :4 99 8A
(Mark whichever is applicable)5: 9 J8 5: 9 J8 5: 9 J8 5: 9 J8
02 38 02 38 02 38 02 38
Name and address of the Other Dealer/Person
Ve Ve 2 to whom the Goods
Ve 2 are Consigned or from whom
V(Buyer2 Goods were Purchased
V 2:
hi : SAINTGOBAIN INDIA PRIVATE hi hi eh or self or Agent or Principal) eh
C
Name cle C cle LTD C cle C icl
TIN : 33511662391 C icl
S /V: SAINTGOBAIN INDIATPRIVATE S /V S /V S e /V S e/
T
Address
28 37 es 28 37 es
LTD AZHAGAPPASAMUDRAM T
28 37 es T
28 37 es T
28 37 Ves
Ju 170 sQuantity
6. Description, el and ValueJofu
17 Goods
the
0
se
l Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
20 28 o. Commodity20 28 o. 20 2Invoice
8 o. No./Date Quantity 20 28 o.Value (Rs.) 20 28
1 1 : 1 1 : 1 1 : 1 1 : 17
7 69 Tsand
neyveli screened N 7 69 TN 7 69 TN / 27-06- 27520.00
1500003852 7 69 TN40,729.00
09 0 1 09 0 1 09 020171 00 KGS09 0 0
:4 99 8A :4 99 8A :4 99 8A : 4 99 18A
5: 9 J8 5: 9 J8 5: 9 J8 TOTAL 5
:0 9 J83
40,729.00
02 38 02 38 02 38 2
2 2 goods are consignedV: 2 82
7. VName of the Owner of the goods V vehicle or vessel by which V the V
eh eh eh eh eh
C icl C icl C icl C icl C icl
e/
TypeSof Transportation S
: Otherthan e/ Transporter Name : SSKMINES e/ Vehicle/VesselS No.e/ : TN18AJ8382 S e/
T
28 37 es
Parcel V
Service T
28 37 es V T
28 37 es V T
28 37 es V T
28 37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 : We n 6 of my/our n particulars n 6trueNand correct. n 6
DECLARATION
20 28 No.certify that to the2best 0 28 No. knowledge the 20 628 No. furnished here2are 0 28 o. 20 28
17 16 : T 17 16 : T 17 16 : T 17 16 : T 17
09 0 19 N 09 0 1 9 N 9
09 0 1 N 9
09 0 1 N 0
:4 99 8A :4 99 8A :4 99 8A :4 99 8A
5: 9 J8 5: 9 J8 5 9 J8 5 9 J
02 38 02 38 Signature of:0the 2 Dealer3to 82
whom Waybill:0issued by83the CTD
2 8
Ve Ve 2 Ve 2 Ve Ve 2
h h h h h
CS icle CS icle CS icle CS icle CS icle
/ / / / /
28 T37 Ves 28 T37 Ves 28 T37 Ves 28 T37 Ves 28 T37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
20 28 o. 20 28 o. 20 28 o. 20 28 o. 20 28
17 16 : T 17 16 : T 17 16 : T 17 16 : T 17
09 0 19 N 09 0 1 9 N 9
09 0 1 N 9
09 0 1 N 0
:4 99 8A :4 99 8A :4 99 8A :4 99 8A
5: 9 J8 5: 9 J8 5: 9 J8 5: 9 J8
02 38 02 38 02 38 02 38
2 2 2 2
CST371706281690999
 Government of Andhra Pradesh
C.T.DEPARTMENT
(Self Printed CST e-Way Bill)

FORM OF WAY BILL FORM X or FORM 600

{See Rules 33(1)(d) & 55(1)&(4)}
Ve Ve Ve Ve Ve
h h h h h
CS icle - CST
TRIPLICATE
CS icle CS icle CS ic: le371706281690999CS icle
Way Bill No.
/V / / / /
28 T3-7NELLORE
DIVISION es 28 T37 Ves 28 T37 Ves 28 T(NAYUDUPETA)
CIRCLE : GUDUR 37 Ves 28 T37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
01 28:1CTD-ON
1. Office of2Issue o.
:
LINE SERVICE 20 28 o.
1 1 :
20 28 2.
1 1
o. Date of Issue : 28
:
20Jun282017
1 1
o. 09:45:02
:
20 28
17
3. Name and address 7 69 ofTthe N Dealer to whom 69 Tissued
7 Waybill N by the CTD7 : 69 TN 7 69 TN
0 0 1 09 0 1 09 0 1 09 0 1 0
Name : SAINT 9GOBAIN :4 99 INDIA 8A PRIVATE LIMITED :4 99 8A :4 99 8A :4 99 8A
Address : PLOT NO 9 J8INDUSTRIAL AREA,KARUR
5: 98,APIIC 5: 9 J8 VILLAGE,TADA,ANDHRA 5: 9 J8PRADESH,NELLORE,524401 5: 9 J8
02 38 02 38 02 38 02 38
TIN : 37370213873
Ve Ve 2 Ve 2 2
STATE : ANDHRA PRADESH
Ve Ve 2
4. Placeh From which consigned : AZHAGAPPASAMUDRAM
h h h
To which consigned : TADA h
CS icle CS icle CS icle CS icle CS icle
T3 /CONSIGNOR
5. IF THE V T /Ve THE GOODS2 : To
IS TRANSPORTING T3the/VBranch 28 T37 Ves
/
28 T37 Ves
/
(a) 2
In8pursuance 8 37to1 the
71 eofsssale for purpose of2delivery sbuyer ; or 8 7 es
(b) AfterJu 70 ethem;
purchasing
l or Ju 70 sel Ju 170 sel Ju 170 sel Ju 170 se
n of the Noor godown to an agentn for 6sale; N n 6 N n 6 N n 6
(c) From one
20 62shops
8 . 20 28 o. 20 28 o. 20 28 o. 20 28
(d) From shop or1godown 1 to:another shop or godown 1 1
for purpose : of storage or sale; or 1 1 : 1 1 : 17
TN them on his behalf
69 purchased
7 having 7 ; or69 TN 7 69 TN 7 69 TN
CST371706281690999

(e) To his principal,

09 0 1 09 0 1 09 0 1 09 0 1 0
(f) To his agent for sale :on
4 99 8A basis.
consignment :4 99 8A :4 99 8A :4 99 8A
(Mark whichever is applicable)5: 9 J8 5: 9 J8 5: 9 J8 5: 9 J8
02 38 02 38 02 38 02 38
Name and address of the Other Dealer/Person
Ve Ve 2 to whom the Goods
Ve 2 are Consigned or from whom
V(Buyer2 Goods were Purchased
V 2:
hi : SAINTGOBAIN INDIA PRIVATE hi hi eh or self or Agent or Principal) eh
C
Name cle C cle LTD C cle C icl
TIN : 33511662391 C icl
S /V: SAINTGOBAIN INDIATPRIVATE S /V S /V S e /V S e/
T
Address
28 37 es 28 37 es
LTD AZHAGAPPASAMUDRAM T
28 37 es T
28 37 es T
28 37 Ves
Ju 170 sQuantity
6. Description, el and ValueJofu
17 Goods
the
0
se
l Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
20 28 o. Commodity20 28 o. 20 2Invoice
8 o. No./Date Quantity 20 28 o.Value (Rs.) 20 28
1 1 : 1 1 : 1 1 : 1 1 : 17
7 69 Tsand
neyveli screened N 7 69 TN 7 69 TN / 27-06- 27520.00
1500003852 7 69 TN40,729.00
09 0 1 09 0 1 09 020171 00 KGS09 0 0
:4 99 8A :4 99 8A :4 99 8A : 4 99 18A
5: 9 J8 5: 9 J8 5: 9 J8 TOTAL 5
:0 9 J83
40,729.00
02 38 02 38 02 38 2
2 2 goods are consignedV: 2 82
7. VName of the Owner of the goods V vehicle or vessel by which V the V
eh eh eh eh eh
C icl C icl C icl C icl C icl
e/
TypeSof Transportation S
: Otherthan e/ Transporter Name : SSKMINES e/ Vehicle/VesselS No.e/ : TN18AJ8382 S e/
T
28 37 es
Parcel V
Service T
28 37 es V T
28 37 es V T
28 37 es V T
28 37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 : We n 6 of my/our n particulars n 6trueNand correct. n 6
DECLARATION
20 28 No.certify that to the2best 0 28 No. knowledge the 20 628 No. furnished here2are 0 28 o. 20 28
17 16 : T 17 16 : T 17 16 : T 17 16 : T 17
09 0 19 N 09 0 1 9 N 9
09 0 1 N 9
09 0 1 N 0
:4 99 8A :4 99 8A :4 99 8A :4 99 8A
5: 9 J8 5: 9 J8 5 9 J8 5 9 J
02 38 02 38 Signature of:0the 2 Dealer3to 82
whom Waybill:0issued by83the CTD
2 8
Ve Ve 2 Ve 2 Ve Ve 2
h h h h h
CS icle CS icle CS icle CS icle CS icle
/ / / / /
28 T37 Ves 28 T37 Ves 28 T37 Ves 28 T37 Ves 28 T37 Ves
Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 sel Ju 170 se
n 6 N n 6 N n 6 N n 6 N n 6
20 28 o. 20 28 o. 20 28 o. 20 28 o. 20 28
17 16 : T 17 16 : T 17 16 : T 17 16 : T 17
09 0 19 N 09 0 1 9 N 9
09 0 1 N 9
09 0 1 N 0
:4 99 8A :4 99 8A :4 99 8A :4 99 8A
5: 9 J8 5: 9 J8 5: 9 J8 5: 9 J8
02 38 02 38 02 38 02 38
2 2 2 2
CST371706281690999