EXCISE AND TAXATION DEPARTMENT Goverment of Himachal Pradesh

Form VAT-XXVI-A [See Rule 61(1)] DECLARATION Acknowledgement No. Acknowledgement Date and Time Form No. E26A2805120001633325 Type of Movement Goods Imported Nature of Transaction Goods for Trade Name CONSIGNOR 9280512000976051 28/05/2012 11:00:56 AM

TVS ELECTRON LTD SELAQUI IND AREA 05006970251 SELAQUI

Consigned from Place

Full Address TIN(VAT/CST) Consigned From City Uttarakhand Name

JAI AMBEY CONTAINER PVT LTD. Nahan Road Main Thappal Kala Amb Distt Sirmour Hp,Mainthappal,Himachal Pradesh 02040400203 KALAAMB Value of Goods (Rs.) 490.34

CONSIGNEE

Destination of Goods Checkpost / Barrier Details of Goods: Sr. No. 1 Vehicle No. HR37B2020 G.R. No. 1

Full Address TIN(VAT/CST) Consigned To City Himachal Pradesh Govindghat

Bill No. 2 4212300156

Quantity (vehicle wise) 3 4 18/05/2012 2 Date

Unit 5 Nos

Brief Description Of Goods 6 Corrugated boxes and mano cartons other than brought by horticulturists and agriculturists Corrugated boxes and mano cartons other than brought by horticulturists and agriculturists Corrugated boxes and mano cartons other than brought by horticulturists and agriculturists Corrugated boxes and mano cartons other than brought by horticulturists and agriculturists Corrugated boxes and mano cartons other than brought by horticulturists and agriculturists

Value Of Goods (Rs.) (vehicle wise) 7 148.25

HR37B2020

4212300157

18/05/2012

Nos

72.12

HR37B2020

4212300160

18/05/2012

Nos

134.99

HR37B2020

4212300158

18/05/2012

Nos

61.05

HR37B2020

4212300155

18/05/2012

Nos

73.93

Transporter details: Sr. 1 Vehicle No. HR37B2020 NA Name of Transporter Co. NA Address of Transporter Co.

EXCISE AND TAXATION DEPARTMENT Goverment of Himachal Pradesh

Form VAT-XXVI-A [See Rule 61(1)] DECLARATION Barrier Clearance Number: Signature or thumb impression ________________ Signature of Officer In-charge of the Name and address of the person transporting the goods. Checkpost/Barrier with stamp to be appended after checking. __________________________________________ __________________________________________ Date ____________________ Date ____________________ This is a computer generated Form VAT XXVI-A for which Rs. 10/- has been deducted/adjusted from the respective balance for e-declaration facility.