Form 403 Declaration under Section 68 of the Gujarat Value Added Tax Act, 2003 DUP LICATE Form

DUP LICATE Form 403 Declaration under Section 68 of the Gujarat Value Added Tax Act, 2003 OR IGINAL
(See sub-rulefil of rule 51) (For goods entring into the State from outside the State) (See sub-rulelb) of rule 51) (For goods entring into the State from outside the State)
To, The officer-in charge, Check-post . To, The officer-in charge, Check-post .
1. Place to which goods are dispatched ~l .( C ' ,- ( 'l t) A District i2 AT II () "'- . 1. Place to which goods are dispatched Il! IS Tt-~ '" A District J: A.:\ k.o "
2. Place from which goods are dispatched District _ 2. Place from which goods are dispatched District _
3. Detials of goods Invoice no. Date _ 3. Detials of goods Invoice no. Date ~_

4. Consignee's Details: (~UC-i. +loll':l'il:<'..{l [q~lnl) Sr.No.: 4. Consignee' s Details: (liIC-i. +lollet'il:<'..{l [q ~lnl) Sr.No.:

Name, Address, Telephone no . & fax no . State Registratioin Certificate No.& Date Name, Address, Telephone no. & fax no.
State Registratioin Certificate No.& Date

Adaoi Food Products Pvt. Ltd. TIN S.T. NO. 24092400094 Dr. 13.9.20 5 Adani Food Products Pvt. Ltd. TIN S.T. NO. 24092400094 DT. 13·g. ~05
. PLOT NO. E 687 B. RO~O. TIN C.S. T. NO. 24592400094Dr. 13-9.2015 TIN C.S.T. NO. 24592400094 DT. 1J.9· 005
PLOT NO. E 687 B. RO~D,

LOD HIKA G,I.D.C. CST Registration No . & Date LODHIKA G.t.D_C.

CST Registration No. & Date
METODA DIST RAJKOT. METODA OIST RAJKOi.
.:
1) Inter State sale ~ 2) R.R.Endorsement o W
5. Nature of Transactio n: 3) Depto Transfer 0 5. Nature of Transaction: 1) Inter State sale 2) R.R.Endorsement o 3) Depto Transfer 0
4) Consignment to Branch / Agent 0 5) For Jobworks / Work contract o
6) Any other 0 4) Consignment to Branch / Agent 0 5) For Jobworks / Work contract o 6) Any other 0
6. Consignor's Details: (liIC-i. lil!sC-i.'iI:<'..{l [q~lnl) 6. Consignor's Details: (liIC-i. lil!sC-i.'iI:<...{l [q~lnl)
Name, Address, Telephone no. & Fax no . State Registrat ioin Certificate No .& Date Name, Address, Telephone no. & Fax no. State Registratioin Certificate No.& Date

CST Registration No . & Date CST Registration No. & Date

Consigned Value Rs : Consigned Value Rs :

S.No . Description of Goods Commodity Code Unit/Quantity Rate of Ta x Value S.No . Description of Goods Commodity Code Unit/ Quantity Rate of Tax Value

7. Transporter's Det ails: a) Name, b)Address. 9. Driver's Details: a) Name, b) Address: 7. Transporter's Details: a) Name, blAddress. 9. Driver's Details: a) Name, b) Address:

c) Driving Licence No . c) Driving Licence No . _

d) Licence issuing State d) Licence issuing State _
c) Owner/Partner's Name: c) Owner/Partner's Name: _
e) Driver's Signature : e) Driver's Signature :
8. Vehical No . 8. Vehical No . _
L.R .No. Date
- L.R .No. Date -­
10. Name and the Address of Person in charge of goods: t!,:cl .~ ~~~1

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Place ft--r i0 ) ~ Dale , ( IO [ Odi .

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Sign atrue~()
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Designation: (SEA L) Designation: (SEAL)
FOR COMMERCIAL TAX DEPARTMENT I CHECK POST FOR COMMERCIAL TAX DEPARTMENT 1CHECK POST
Entry No . Reason of abnormal stoppage Resu lt if any Entry No . Reason of abnormal stoppage Result if any
Vehical Date Time Vehi cal Date Time
Arrival Arrival
Departure Departu re

Date Signature: Designation:

I VAT FonnAvailable at MAHARANIDAS: Sanganwa Chowk 0 2224118 l~ Opp.Gurukul, Gondal Road 0 2365412 · RAJKOT