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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:
Office of LVO of the Person Uploading (a) Name and Address of the Dealer Uploading (b) TIN I. (c) Date of Uploading the details

2023147071
LVO-0320 VINAYAK ENTERPRISES (PATILMOHAN,HUBLI) 29840001393 04/11/2011 05:11 PM 14/11/2011 VAPI DANDELI OTHERS - GAUGES AND ACCESSORIES 51NOS Rs.61156 VRL

(d) Date of Transportation of goods/Likely date of entry of goods Place II. (i) From (ii) To III . Description of the goods(i) Name or class of goods consigned. (ii)Quantity or weight. (iii)Value of the goods. (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. . (iii) GC/LR No. (iv) GC/LR Date V. Category of Transaction Details of consignor and Consignee as Per Category: (i) TIN of Consignor (ii) Name and address of Consignor VI . (iii) TIN of Consignee (iv) Name and address of Consignee (v) Document No. (vi) Document Date.

Inter State After Purchase

24250702137 WAAREE INSTRUMENTS LTD ,VAPI,GUJRAT 29840001393 (PATILMOHAN,HUBLI) 4111103861 - Invoice 04/11/2011

Date & Time of Printing 04/11/2011 05:11 PM


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