Date : …...........................

TO WHOM SO EVER IT MAY CONCERN

Consignor's Name & Address: Consignee's Name & Address :

Pin Code : Pin Code :

Contact Number: Contact Number:

Dear Sir/Madam,
I Madhav Acharya a resident of -------------------------------------------
Identification Number --------------------------------------
Want to send the below mentioned goods to Darbhanga Bihar- 874302.

The goods to be transported are:

S. No. List / Description of Items Amount

1
2
3
4

10

DECLARATION
I hereby declare that the shipment booked via Docket Number , is for
Personal use only and does not have any commercial value.

Customer's Signature