FORM VAT 402 Electronic

WAY BILL
[See sub-rule (3) of rule 79]

Confirmed and Printed On: 09/03/2017 18:07:02

1. Dealer of Odisha
(To whom waybill is issued
Name: KANTI SPORTS

21W-17069058898
TIN: 21441203284

2. Consignor of goods
Name: mayur handicrafts

Address: muradabad
TIN: 09658905252

3. Place of Despatch of goods 4. State of Despatch of goods 5. Date of Despatch of goods

muradabad Uttar Pradesh (Actual/Expected Date)
9/3/2017

6. Name of entry/exit check gate: Jamsolaghat

WAY BILL No:

7. Consignee of goods
Name: KANTI SPORTS

Address: HOLDINGNO.734/C/2,WARDNO.29 CUTTACK BUXIBAZAR HARIPUR ROAD

TIN: 21441203284 CST No: 21441203284

8. Consigner despatching goods for [(Tick) Mark in the appropriate box]

Delivery to the After purchase Branch Consignment Execution of Transfer of Any Other
buyer by self/by agent transfer sale works contract right to use reason,(plea
se specify)
Yes

9. Details of Invoice / Challan / Other document(s)

Sl.N Commodity & Code Invoice / Challan (in case of Quantity Value (in Rs)
o sale / Purchase) / Other
document (other than sale /
purchase)
Sl. Number Date
1 Other sports and games articles-950699 022 28/2/2017 7.0000 54,600.00

Packets

10. Vehicle / Carrier Detail - Vehicle Regd. Driver's Name Lorry / Transport / Railway
21W-17069058898
No. no Receipt No.
no no

Owner of Vehicle Transporter's Name and Address

no star cargo

11. Way bill issuing/approving Office 12. Way bill issuing/approving authority (Name &
Desgination)
Cuttack-I City Circle
WAY BILL No:

System Generated Waybill

13. Declaration of the Dealer of Orissa to whom Way bill issued Seal
I hereby indemnify the Government / Department / Officer (s) concerned
from any liabilities arising out of the use / misuse of this system generated Date of Approval: 9/3/2017/ 6:05:40PM 21441203284

electronic Waybill.