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Certificate No : 7677181952/2017 Application No : 320000/F16/18834/2017 Issued on :02-06-2017 12:06 PM

THE KERALA VALUE ADDED TAX RULES, 2005

Form No.16 (Downloaded Online)
CERTIFICATE OF OWNERSHIP
[See Rules 58 (18)]
:AHAMMED KUTTY . P . T, ,
PEETEE HOUSE , PARAYANTHODIKA HIGH SCHOOL
ROAD, ,NEAR TALUK LIBRARY,
1.Full name and addres of the person who owns the goods. KALATHINKADAVU, NILAMBUR,
NILAMBUR, MALAPPURAM, 679329,
(Aadhaar No., 639576580464), 9447832823, 9953222339
:PEETEE
2.The name of the place to which the goods are transported. HOUSE, KALATHINKADAVU, NILAMBUR, NILAMBUR
MUNICIPALITY, KERALA, 679329
The name and the No.of the vehicle/vessel through which the goods are
3.transported. :
: THESAUROS, 203 A, DLF MEGA MALL, GOLF
4.The place from which the goods are transported COURSE ROAD, GURGAON - 122002 (HARYANA) TIN
NO.- 06671827697, Haryana
5.The purpose for which the goods are transported : SELF USE
If for sale, the name and address of the person to whom he(the
owner of the goods) usually
6.sell goods(if the purchaser is a registered dealer,the registration certificateNo. :
and the officer in which is registered should also be given)

DETAILS OF GOODS TRANSPORTED

Number of
Extent of agricultural holdings
packages/ The value of the goods
Commodity Weight with Survey No. of the person
cases/bundles/bags estimated
mentioned in item(1)
etc.
MODULAR KITCHEN &
ACCESSORIES Built in hob and chimey 2.00 PACKET 36.00 KGs 39698
for modular kitchen

DECLARATION

I/We AHAMMED KUTTY . P .

T declare that to the best of my/our knowledge that the information furnished above is true and correct.

Place: Name and Signature of the owner of the goods

Date:

Issued by Department of Commercial Taxes through KVATIS Printed on: 02/06/2017 12:42 PM

1 of 1 6/2/17, 12:54 PM