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FORM 50 {See rule 71} Declaration Under section 57 of the Madhya Pradesh Vat ct!

"00" in res#ect of $oods %elon$in$ to a #erson& 1 (a) Name and complete address of the consignor (b) Registration certificate No. under the State Sales Tax law of the appropriate State (if any) Name and complete address of the consignee !lace from which the goods dispatched. #onsignor$s in%oice No. and date 'estination (including complete address) )rief description of goods Total +uantity or total weight Total %alue (a) name and address of the carrier (transport company or owner of the %ehicle etc.) and %ehicle number (b) )ilty . /R No. and date

2 " & ( * , -

01 222222222222222222 declare that to the best of my 3nowledge and belief the abo%e statements are true and correct. !lace 'ate Seal and signature of the consignor of the goods (To be completed in the office of the chec3 post) 'ate and time of arri%al of the %ehicle at the chec3 post 2222222222 'ate and time of departure of the %ehicle from the chec3 post 2222222 Reasons for abnormal detention of the %ehicle at the chec3 post 22222222 Seal 'ate Signature and designation

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