ORIGINAL FOR BUYER

TAX INVOICE CUM DELIVERY CHALLAN

(Removal of Excisable Goods from a Factory under Rule 11 of Central Excise Rules 2002 & Rules of CENVAT credit rules 2004)

DOLPHIN POLYMERS
Reg. Office & Factory : R.S.No. 627/1 & 631/1, # 6-23, Main Road, PERIKIGUDEM, Mandavalli Mandal, Krishna District-521 345. Ph : 08677-280099 E.C.C.No. : Range : Division : Commisionerate : Commodity : Heading No. AAHFD5873DEM001 VUYYURU (CODE - 04) VIJAYAWADA (CODE - 02) GUNTUR (CODE - 22) Thermocol(EPS) Boxes / Lids / Blocks / Sheets (Shape Moulding Products) : 39231090 39219010

INVOICE NO : Our TIN No. :

Chapter Heading No. Description of the Commodity : Date of Preparation : Time of Preparation : CST No. : 28203536161

I.D. Marks

Date of Removal : Time of Removal :

Name and Address of Consignee :

Your Order No. : Our Sale Order No. : Delivery Order No./Shipment No.: Mode of Transport - by Road : Transporter : Lorry Receipt No. : LST No. :

CST No. Payment Terms Due Date Rate of Duty @ Sl. No. Description of Goods Avg. Contents / Package No. of Packs

: : : : Quantity (MT) Rate (Rs./MT) Total Assessable Value in (Rs.)

GRAND TOTAL
Amount in Words : Excise duty in Words :

Sl. No. & Date of Debit entry in PLA/RG23A Part-II/RG23C Part-II :

Declaration : Certified that the particulars given above are true and correct and the amount indicated represents the price actually charged and that there is no flow of additional consideration directly or indirectly from the Buyer. Terms : 1. All disputes subject to Kaikalur Jurisdiction only. 2. Goods once sold will not be taken or exchanged. 3. If payment is not made within seven days interest will be charged @24% p.a.,

For

Dolphin Polymers

Documents Routed thru :

Checked by

Authorised Signatory

ORIGINAL FOR BUYER

DUPLICATE FOR TRANSPORTER TRIPLICATE FOR ASSESSEE QUADRUPLICATE FOR F&A / NOT FOR CENVAT QUINTYPLICATE FOR CTD COPY / NOT FOR CENVAT