3GST063833150102185615262

FORM 403
(See rule 138)
Declaration under Section 68 of The Gujarat Goods & Services Tax Act, 2017
(For goods entering into the state from outside the State)

Form No. 979850975

Date: 16-FEB-2018 11:03:04 AM
To,
The Proper Officer
Validation Unit BHILAD
(1) Place to which goods are dispatched : Gujarat District : VADODARA
(2) Place from which goods are dispatched : Maharashtra District : NASIK
(3) Details of goods :

Sr. No. Invoice No. Invoice Date

1 NSKVM0432 15/02/2018
(4) Consignee’s/Recipient's details :
Name V.G. AUTOMOBILES State Gujarat
Address NH 8 Vadodara ByPass GSTIN No. 24ADZPP9289N1Z3
Date 15/07/2017 Telephone 9898000592
Fax No.
(5) Nature of Transaction : Inter State Supply
(6) Consignor’s/Supplier's details :-
Name CHEMITO INFOTECH PVT LTD GSTIN No. 27AAACC2873N1ZC
Address D1 27 M I D C AMBAD NASIK 422011 Date
Telephone Fax No.
Consigned Value Rs.1085600
Sr. Description of Goods Commodity Unit Unit Rate of Commodity Invoice No.
No. Code Quantity Measure Tax Value
1 Motor vehicles for the trasport of goods such 87040000 10 Nos 28 1085600 NSKVM0432
as dumpers, lorries and trucks and other
(7) Transporter’s Details :
(a) Name : JAY AMBE TRANSPORT
(8) Conveyance No : i) MH15EG7563 ii) L.R.No. :41217 Date :15/02/2018
(9) Driver’s Details:
(a) Name : (b) Driving License No. : (c) License issuing State :
(d) Driver’s Signature : (e) Address :
(10) Name and the address of person in charge of goods __________________________
Seal :
Place: ____________________Date: ____________________Designation: _______________________Signature: _______________________

For Validation Unit

Entry No. Reason of Abnormal stoppage Result if any
Conveyance Date Time
Arrival
Depart

Date: ________________ Signature: _________________ Designation: _________________