Original/Duplicate

THE WEST BENGAL VALUE ADDED TAX RULES, 2005 FORM 50A
Printed On: 25/11/2012 12.05 PM
Way bill for transport of consignment of goods despatched from Outside West Bengal to any place inside West Bengal

[See rule 110B read with rule 100A,rule 103A and rule 104A] Waybill Serial No. Waybill Key No. Office of issue Date of generation of the Waybill in form 50A Valid upto 192012113876383 T1920120507041044 Directorate of Commercial Taxes,West Bengal 25/11/2012 12.05 PM 25/12/2012

1.Name and Address of the Dealer/Person Importing the goods a)VAT RC No b)CST RC No c)Trade Name d)Address of principal place of Business 19801345067 19801345261 JAYSHREE AUTOMOBILES INDIA PVT. LTD. , NEAR GANDHI MORE, FARIDPUR, DURGAPUR District-BARDHAMAN e)PIN f)PAN 713213 AACCJ2993G

2.Name and Address of the Dealer/Person from whom the goods are purchased/imported a)VAT RC No b)CST RC No c)Trade Name d)Address of principal place of Business 06411301809 FBD/1301809 JCB INDIA LIMITED 23/7 MATHURA ROAD BALLABGARH e)PIN f)PAN g)State of India/Union Territory of India/Country other than India 3.Mode of transport of goods in West Bengal 4.Registration Certificate No. of the Vehicle HARYANA 121004 AAACE0078P HARYANA Road PB13G.2638

5.Name and Address of the Transporter/Owner of the vehicle by which the goods are transported R.S. ENTERPRISES a)Name b)Address 107, Sector-9 Faridabad-121006 Haryana c)Enrolment No. under the WB VAT Act 2003(if any) 6.Detail of Consignment Note/Railway Receipt/Airway Bill/Bill of Landing/ Bill of Entry or similar document No. 4336 & 4337 Date 21/11/2012 2

7.Total No. of Invoices/tax invoices/cash memos/bills/challans/forwarding notes(details as per Annexure to

8.Total Value of Goods(details as per Annexure to 50 A) 9.Possible Entry location in W.B

Note a) Name of the District, if transport by road b)Name of the railway station/port/airport,if transport by rail/sea/air

3815940.70 DUBURDIH

Declaration-*I/We declare that the information furnished as above are correct to the best of my/our knowledge and belief.

Signature Name of the person signing the Waybill Status of the person signing the Waybill [in relation to the importing dealer]. #Proprietor/Partner/Director/Authorised Person, etc
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THE WEST BENGAL VALUE ADDED TAX RULES, 2005 ANNEXURE TO WAYBILL IN FORM 50A
Details of Invoices / Tax Invoices / Cash Memos / Bills / Challans / Forwarding Notes and of goods in relation to Sl. No. 7 and Sl. No. 8 of Waybill in Form 50A Original/Duplicate Printed On: Waybill Serial No Waybill Key No. Office of issue Date of generation of the waybill in Form Valid upto 192012113876383 T1920120507041044 Directorate of Commercial Taxes, West Bengal 25/11/2012 12.05 PM 25/12/2012 25/11/2012 12.05 PM

Details of Invoice/tax invoice/cash memo/bill/challan/forwarding note etc. and description,quantity and value of goods

Invoice/bill/challan/for Invoice Date warding note etc.

6310012810 21/11/2012

Commodity Name
JCB 3DX BS-III BACKHOE

Quantity
1.00

Unit
NUMBE R

Nos of Packages
1

Value of Goods
1907970.35

6310012811

21/11/2012

JCB 3DX BS-III BACKHOE

1.00

NUMBE R

1907970.35

Declaration-*I/We declare that the information furnished as above are correct to the best of my/our knowledge and belief Signature Name of the person signing the declaration Status of the person signing the declaration [In relation to the importing dealer]
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