FORM VAT 402

Electronic

WAY BILL
[See sub-rule (3) of rule 79]
20/07/2016 10:31:14

Confirmed and Printed On:

Dealer of Odisha
(To whom waybill is issued
Name:
KB MOTORS

TIN:
2.

21283502078

Consignor of goods
Name:
M/S. HEMANT INDUSTRY.

Address:
TIN:

4451, ARYA PURA SUBZI MANDI, DELHI-110007.

07740201728

Place of Despatch of goods

ODISHA

4. State of Despatch of goods

The Government of NCT of Delhi

6.

Name of entry/exit check gate:

Jamsolaghat

7.

Consignee of goods
Name:
KB MOTORS

Address:

5. Date of Despatch of goods

(Actual/Expected Date)
20/7/2016

WAY BILL No:

3.

8.

GEETAGRAM ANGUL P.T.C GEETAGRAM

TIN:
CST No:
21283502078
Consigner despatching goods for [(Tick) Mark in the appropriate box]
Delivery to the
buyer

After purchase
by self/by agent

Branch
transfer

Consignment
sale

21283502078
Execution of
works contract

Transfer of
right to use

Yes
9.
Sl.N
o

21W-16172150279

1.

Any Other
reason,(plea
se specify)

Details of Invoice / Challan / Other document(s)

Commodity & Code

Automobile Parts and Accessories-8708

Invoice / Challan (in case of

sale / Purchase) / Other
document (other than sale /
purchase)

Sl. Number

Date

09

20/7/2016

Quantity

Value (in Rs)

6.0000

36,720.00

11.

Vehicle / Carrier Detail - Vehicle Regd.

No.
NA

Driver's Name
NA

Lorry / Transport / Railway

Receipt No.
NA

Owner of Vehicle
NA

Transporter's Name and Address

GREAT NDIA ROADWAYS

Way bill issuing/approving Office

12. Way bill issuing/approving authority (Name &

Desgination)

Angul Circle

System Generated Waybill

13.

Declaration of the Dealer of Orissa to whom Way bill issued

Seal

I hereby indemnify the Government / Department / Officer (s) concerned

from any liabilities arising out of the use / misuse of this system generated
electronic Waybill.

Date of Approval:

20/7/2016/10:31:00AM

21283502078

WAY BILL No:

10.

21W-16172150279

CARTOON BOX