9992411020062601111236581

FORM 403 (See sub-rule (5) of rule 51) (For goods entering into the State from outside the State)

Declaration under Section 68 of the Gujarat Value Added Tax Act, 2003 Form No. 121286205 Date: 06-NOV-2012 02:06:44 PM To, The officer in charge Check post BHILAD
(1) Place to which goods are dispatched : Gujarat District : NAVSARI (2) Place from which goods are dispatched : Maharashtra District : Thane (3) Details of goods :

Sr. No. 1
(4) Consignees details :

Invoice No. 1038

Invoice Date 06/11/2012

Name Address Telephone Fax No.

SOMA ENTERPRISE LTD NATIONAL HIGHWAY,RANAKANDORANA,RANAKANDORANA,PORBANDAR

State Registration No. Date Cst No. Date

Gujarat 24110200626 01/09/2006 24610200626 08/09/2006

(5) Nature of Transaction : Depot Transfer (6) Consignors details :

Name Address Cst No. Date Consigned Value Rs.25000 Sr. No. 1

Soma Enterprise Limited Kandarvan Village Palghar Taluka 27690170822 01/04/2006

Registration No. Date Telephone Fax No.

27690170822 01/04/2006 8007778138

Description of Goods IRON AND STEEL (SCHEDULE II, ENTRY 43)

Commodity Unit Unit Rate of Commodity Code Quantity Measure Tax Value 19055 49 Nos 0 25000

Invoice No. 1038

(7) Transporters Details :

(a) Name : Soma Enterprises Limited

(8) Vehicle No : i) GJ21T7616 ii) (9) Drivers Details: L.R.No. :1038 Date :

(a) Name : Prasanth Biswal (d) Drivers Signature :

(b) Driving License No. : OR 0420030002409 (c) License issuing State : Orissa (e) Address : Haraspada Khandahata Brahmadiri Puri

(10) Name and the address of person in charge of goods __________________________ Seal : Place: ____________________Date: ____________________Designation: _______________________Signature: _______________________ For Commercial Tax Department/Check post

Entry No. Vehicle Arrival Depart

Date: ________________ Designation: _________________

Reason of Abnormal stoppage Date Time

Result if any

Status: _________________