Government of Madhya Pradesh

"e-Form 49"

Commercial Tax Department

[See rule 70(3)]

Declaration

Form 49: I462713

IN
Indore Circle-9

Issue Date and Time

20 April 2016 11:42 AM

Form Validity

Name and Address

AMBE-G ENTERPRISES,
203, APOLLO TOWER, 2, M.G. ROAD, INDORE

Name and Address

JM Fashion
Gnf28, Kamla Nagar, Jasmine mill Rd, near ghasitaram sweets Ind. MAHIM.E Mumbai.

04 May 2016

Details of MP Dealer
TIN

23860904066

TIN

27735296862

Details of Form 49:

S.
Invoice No and Date
No
1

243, 20/04/2016

t
e:
lid
up 11 20to :42 AP
:0
R
A
-2
4M
01
MA
6
Y20
16

Details of Other State Dealer

Destination

Goods Category

All kinds of hosiery goods and readymade garments.

Indore

Goods
Description

Total
Quantity/
Weight

readymade garments

Total

Place from which goods dispatched

Total Value

39

27810

27810

mumbai

Carrier ( Transport company or owner of the vehicle etc )

Name and Address
Bilty No and Date

Vehicle Number

I as consignor declare that all the details given above are true and correct
Place :

Date :

Signature and Name of authorized person

Da

To be completed in the office of the checkpost ( Not required when computer generated printed e-gate pass is given)
Date and time of Entry/Exit of vehicle at check post

Va

Iss

Designation

ue

Seal and Signature

Date :