DECLARATION FORM

Document No. :- 1125 Document Date :- 1/25/2021

CONSIGNOR ADDRESS CONSIGNEE ADDRESS

Name Shubham Verma Name Apruv Verma
Noida Sector 63 2c-504,Suncity gloria
Apartments Sarjapur
Rd, Carmelaram,
Ambedkar Nagar,
Address With Chikkabellandur,
Pincode Address With Pincode
City Name Noida City Name Bengaluru
State Name 201301 U.P. State Name Karnatka-560035
Phone No. 8800472320 Phone No. 8800472320
GSTN URP GSTN URP

S No. Product Name Description of goodQuantity (No. of PiecesValue

1 Household Bags And Carton 6 20000
2
3
4
Total Value of goods 20000

Total No. of Boxes 6

Declaration : - I hereby declare that the goods handedover by me to the transporter are my personal goods.
Further these used/old House Hold goods bear no commercial value and are not for sale.
1.Driving License
2.Adhar Card 3.
Voter Card 4.
Note: - 1. Photo Address Proof is attached
Passport 5. here with Photo Address Proof
Photo Address Others (Specify) Proof No.
Proof Type

Name of the person

Signature