Government of Karnataka

(Department of Commercial Taxes)

e-SUGAM FORM
See sub Section(2-A) of Section 53 read with Rule 157(1)(a)
Sl.No:18777514715

Office of LVO of the Dealer Uploading

(a) Name and address of the Dealer Uploading

LVO-040
RELIANCE INFRATEL LIMITED

(b) TIN

29360748363

(c) Date of Uploading the details

20/06/2016 12:56 PM

(d) Date of Transportation of Goods

Place:

20/06/2016

(i) From

HYDERABAD

(ii) To

BANGALORE

II
(iii) Transit Place (if any)
Description of the goods:
(i) Name of goods consigned

OTHERS HANDHOLE,PRECAST,RCC,1TR,600DX800H MM

(ii) Quantity or weight

60
III

(iii) Taxable Value

253320
(iv) VAT/CST Collected
0
(iv) Other Amount if any
0
(v) Total Amount
(i) Name and address of the owner of the goods
vehicle or vehicle by which the goods are
consigned

IV

(ii) Registration number of the goods vehicle or

vessel

253320
A.MADHU SHAKER

AP21Y2657

(iii) GC/LR No.

(iv) GC/LR Date

VI

(v) Transporter Mobile No (if any).

Category of Transaction
Details of consignor and consignee as per Category:

Inter State After Purchase

(i) TIN of Consignor

36987167039

(ii) Name and address of Consignor

SRAVANTHI CONSTRUCTIONS,IDA
JEDIMETLA.HYDERABAD. TELANGANA 500055

(iii) TIN of Consignee

29360748363
(iv) Name and address of Consignee
RELIANCE INFRATEL LIMITED
(v) Document No.
SRA13 - Invoice
(vi) Document Date
20/06/2016

Date & Time of Printing: 20/06/2016 12:56 PM