12/1/2017

FORM-EWay Bill-01
Department of State Taxes/Commercial Taxes, Goverment of
Uttar Pradesh
Form of Declaration for import
Original Copy

EWay Bill-01 Serial No 1712W195900400021819 This EWay Bill-01 Number is valid upto 04/12/2017
Date of Issue 01/12/2017
Assessment Office Addl. Commissioner Gr-1, Etawah
GSTIN 09AADAT3563B1ZM
Name of Dealer TATA ALDESA (JV)
Address of Dealer Saraswathi Palace,Ambaynagar,NH-2,Firozabad Road
1. Description of Goods 1 IN 12 SET
2. Weight / Measure 33.00-Tonne
3. Quantity 70-Piece
4. Value in Figure 261445.00
Rupees Two Lakh Sixty One Thousand Four Hundred Forty
5. Value in Words
Five Only
6. Bill/ cash memo/ challan/ tax invoice number & date (EAL/ANTRI/17/18/328,01/12/2017)
7. Goods Destination Place New Tundla
ECON ANTRI LIMITED Opp Antri Railway Station Antri Distt
8. Name and Address of seller / consignor
Gwalior MP
9. TIN of seller / consignor 23AAACE5310L1ZO

I, -------------------------------------------------------------, the authorized signatory of the above named dealer;do hereby

declare that the goods noted above are being imported/received/brought by the aforesaid dealer.

This EWay Bill-01 is online generated and as such does not require any signature of importer/seller.

Signature of authorized signatory

Pankaj RoadwaysOpp Aara Machine Parking T.P. Nagar
1. Name & address of the Transporter / carrier etc.
Gwalior (MP)
2. Service Provider no. of the carrier, if any 0145
3. Carrier/ Truck no. MP07HB2326
4. Name & address of Driver Dharmendra
5. Driving License No.
6. Signature of the vehicle driver.

Demand No : D1712500029020
Single ( Original ) Printed On : 01/12/2017 18:57:15
(171200032612)

1/2
12/1/2017

FORM-EWay Bill-01
Department of State Taxes/Commercial Taxes, Goverment of
Uttar Pradesh
Form of Declaration for import
Second Copy

EWay Bill-01 Serial No 1712W195900400021819 This EWay Bill-01 Number is valid upto 04/12/2017
Date of Issue 01/12/2017
Assessment Office Addl. Commissioner Gr-1, Etawah
GSTIN 09AADAT3563B1ZM
Name of Dealer TATA ALDESA (JV)
Address of Dealer Saraswathi Palace,Ambaynagar,NH-2,Firozabad Road
1. Description of Goods 1 IN 12 SET
2. Weight / Measure 33.00-Tonne
3. Quantity 70-Piece
4. Value in Figure 261445.00
Rupees Two Lakh Sixty One Thousand Four Hundred Forty
5. Value in Words
Five Only
6. Bill/ cash memo/ challan/ tax invoice number & date (EAL/ANTRI/17/18/328,01/12/2017)
7. Goods Destination Place New Tundla
ECON ANTRI LIMITED Opp Antri Railway Station Antri Distt
8. Name and Address of seller / consignor
Gwalior MP
9. TIN of seller / consignor 23AAACE5310L1ZO

I, -------------------------------------------------------------, the authorized signatory of the above named dealer;do hereby

declare that the goods noted above are being imported/received/brought by the aforesaid dealer.

This EWay Bill-01 is online generated and as such does not require any signature of importer/seller.

Signature of authorized signatory

Pankaj RoadwaysOpp Aara Machine Parking T.P. Nagar
1. Name & address of the Transporter / carrier etc.
Gwalior (MP)
2. Service Provider no. of the carrier, if any 0145
3. Carrier/ Truck no. MP07HB2326
4. Name & address of Driver Dharmendra
5. Driving License No.
6. Signature of the vehicle driver.

Demand No : D1712500029020
Single ( Second ) Printed On : 01/12/2017 18:57:15
(171200032612)

2/2