Government of Karnataka

(Department of Commercial Taxes)

e-SUGAM FORM

see sub section(2-A) of section 53 read with rule 157(1)(a)

SI. No: 20067952074

Office of LVO of the Person Uploading LVO-070

I. (a) Name and address of the dealer Uploading E-Computers
(b) TIN 29381188732
(c) Date of uploading the details 16/11/2018 10:59AM
(d) Date of transportation of goods/Likely date of entry of goods 16/11/2018

II. PLACE
(I) FROM Bangalore
(II) TO Lucknow
III. Description of the goods-
(i) Name or class of goods consigned Acer E5, LCD
(ii) Quantity or weight 2
(iii) Taxable value Rs. 14800.00
(iv) VAT/CST collected Rs. 1776.00
(v) Total amount. Rs. 0.00
Rs. 16576.00
IV. (i) Name and address of the owner of the goods vehicle or by vehicle
by which the goods re consigned.
(ii) Registration number of the goods vehicle or vessel
(iii) GC/LR No.
(iv) GC/LR Date

V. Category of transaction Inter State After sale

VI. Details of consignor and consignee as per category:
(i) TIN of Consignor 29381188732
(ii) Name and address of Consignor (SONAL R SHAH
,MAGADI MAIN ROAD,
BANGALORE)

(iii) TIN of Consignee 12000000000

(iv) Name and address of Consignee Sanket Karandikar

(v) Document no. R5 1417776912212994

(vi) Document date. -Invoice
16/11/2018

Date and Time of Printing 16-11-2018 10:59 AM