Original/Duplicate

THE WEST BENGAL VALUE ADDED TAX RULES, 2005 FORM 50A
Printed On: 06/04/2013 4.00 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 192013044795106 T1920130611927289 Directorate of Commercial Taxes,West Bengal 06/04/2013 4.00 PM 06/05/2013

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 19601130083 19601130277 PIONEER INDUSTRIAL CORPORATION , 140A,S P MUKHERJEE R, OAD,CALCUTTA District-KOLKATA e)PIN f)PAN 700026 ADAPA2258D

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 SAUDI BASIC INDUSTRIES CORPORATION PO BOX 59090 RIYADH 11525 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 5.Name and Address of the Transporter/Owner of the vehicle by which the goods are transported a)Name b)Address FOREIGN COUNTRY Sea SAUDI ARABIA 000000

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. MSCUDM658391 Date 03/03/2013 1

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

2024574.75 N S DOCK

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
1 of 2

75 Unit METRI C TON Nos of Packages 990 BAGS Value of Goods 2024574. West Bengal 06/04/2013 4. 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 192013044795106 T1920130611927289 Directorate of Commercial Taxes.00 PM Details of Invoice/tax invoice/cash memo/bill/challan/forwarding note etc. No. 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] 2 of 2 . No. and description.quantity and value of goods Invoice/bill/challan/for Invoice Date warding note etc. PLASTIC POWDER. 7 and Sl.00 PM 06/05/2013 06/04/2013 4.THE WEST BENGAL VALUE ADDED TAX RULES. 100569286 Commodity Name Quantity 24. 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.75 03/03/2013 PLASTIC GRANULE.

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