Original/Duplicate

THE WEST BENGAL VALUE ADDED TAX RULES, 2005 FORM 50A
Printed On: 30/11/2013 4.16 PM
Way bill for transport of consignment of goods despatched from Outside West Bengal to any place inside West Bengal

[See rule 110B read with rule 100A,rule 103A and rule 104A] Waybill Serial No. Waybill Key No. Office of issue Date of generation of the Waybill in form 50A Valid upto 192013116385983 T1920130791837166 Directorate of Commercial Taxes,West Bengal 30/11/2013 3.54 PM 31/12/2013

1.Name and Address of the Dealer/Person Importing the goods a)VAT RC No b)CST RC No c)Trade Name d)Address of principal place of Business 19743414048 19743414242 ASANSOL STEEL CASTINGS (P) LTD. , SRIPUR VILLAGE ROAD, BURDWAN District-BARDHAMAN e)PIN f)PAN 713303 AACCA1575D

2.Name and Address of the Dealer/Person from whom the goods are purchased/imported a)VAT RC No b)CST RC No c)Trade Name d)Address of principal place of Business 09802500118 09802500118 N.K.IRON INDUSTRIES C-3 FOUNDRY NAGAR AGRA e)PIN f)PAN g)State of India/Union Territory of India/Country other than India 3.Mode of transport of goods in West Bengal 4.Registration Certificate No. of the Vehicle UTTAR PRADESH Road UP75H9008 282006

5.Name and Address of the Transporter/Owner of the vehicle by which the goods are transported Bihar Assam Road Transport Corporation a)Name b)Address Shadara chungi Agra

c)Enrolment No. under the WB VAT Act 2003(if any) 6.Detail of Consignment Note/Railway Receipt/Airway Bill/Bill of Landing/ Bill of Entry or similar document No. 112 Date 30/11/2013 1

7.Total No. of Invoices/tax invoices/cash memos/bills/challans/forwarding notes(details as per Annexure to

8.Total Value of Goods(details as per Annexure to 50 A) 9.Possible Entry location in W.B

Note a) Name of the District, if transport by road b)Name of the railway station/port/airport,if transport by rail/sea/air

1084442.00 OTHERS

Declaration-*I/We declare that the information furnished as above are correct to the best of my/our knowledge and belief.

Signature Name of the person signing the Waybill Status of the person signing the Waybill [in relation to the importing dealer]. #Proprietor/Partner/Director/Authorised Person, etc
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THE WEST BENGAL VALUE ADDED TAX RULES, 2005 ANNEXURE TO WAYBILL IN FORM 50A
Details of Invoices / Tax Invoices / Cash Memos / Bills / Challans / Forwarding Notes and of goods in relation to Sl. No. 7 and Sl. No. 8 of Waybill in Form 50A Original/Duplicate Printed On: Waybill Serial No Waybill Key No. Office of issue Date of generation of the waybill in Form Valid upto 192013116385983 T1920130791837166 Directorate of Commercial Taxes, West Bengal 30/11/2013 3.54 PM 31/12/2013 30/11/2013 4.16 PM

Details of Invoice/tax invoice/cash memo/bill/challan/forwarding note etc. and description,quantity and value of goods

Invoice/bill/challan/for Invoice Date warding note etc.

84 30/11/2013

Commodity Name
CAST IRON CASTING

Quantity
750.00

Unit
PIECES

Nos of Packages
750

Value of Goods
1084442.00

Declaration-*I/We declare that the information furnished as above are correct to the best of my/our knowledge and belief Signature Name of the person signing the declaration Status of the person signing the declaration [In relation to the importing dealer]
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