Government of Madhya Pradesh "e-Form 49" Form 49: I7AA3A7

Commercial Tax Department [See rule 70(3)]

Declaration

IN
Indore Circle-10

Issue Date and Time 15 May 2017 12:28 PM Form Validity 29-MAY-2017

Details of MP Dealer

17
TIN 23020701798 Name and Address RISHABH ENTERPRISES,

17
1-2, Vasundhara Complex NX, 1 Malgodam Road, New
Siyaganj, Indore, INDORE, Madhya Pradesh

0
20
: 2 PM Y-2
Details of Other State Dealer
TIN N.A. Name and Address JAGTESHWARI STEELS,
JALANDHAR

Y-
to 8 A
MA
Details of Form 49
S.N Invoice No and Date Destination
o
up 2:2 5-M
Goods Category Goods
Description
Total
Quantity/Weight
Total Value

1 76, 15/05/2017 INDORE Iron and Steel as specified in clause (iv) 21 129541

9-
of Section 14 of the Central Sales Act,
1956 (No.74 of 1956)
lid 1 : 1

Total 129541

Place from which goods dispatched JALANDHAR

te

Carrier (Transport company or owner of the vehicle etc)

Name and Address
Da

Bilty No and Date Vehicle Number

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

Date: Signature and Name of authorized person

Iss

Va

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
Seal and Signature Date:
Designation