THE WEST BENGAL VALUE ADDED TAX RULES, 2005

FORM 50AWay bill for transport of consignment of goods despatched from Outside West Bengal to any place inside West Bengal

[See rule 110B read with rule 100A,rule 103A and rule 104A]

Original/Duplicate

30/11/2013 4.16 PMPrinted On:

Waybill Key No.

Office of issue

Valid upto

1.Name and Address of the Dealer/Person Importing the goods

a)VAT RC No

b)CST RC No

c)Trade Name

d)Address of principal place of Business

e)PIN

f)PAN

2.Name and Address of the Dealer/Person from whom the goods are purchased/imported

a)VAT RC No

b)CST RC No

c)Trade Name

d)Address of principal place of Business

e)PIN

g)State of India/Union Territory of India/Countryother than India

5.Name and Address of the Transporter/Owner of the vehicle by which the goods are transported

a)Name

b)Address

6.Detail of Consignment Note/Railway Receipt/AirwayBill/Bill of Landing/ Bill of Entry or similar document

7.Total No. of Invoices/tax invoices/cash memos/bills/challans/forwarding notes(details as per Annexure to

Declaration-*I/We declare that the information furnished as above are correct to the best of my/our knowledge and belief.

Date of generation of the Waybill in form 50A

f)PAN

3.Mode of transport of goods in West Bengal

4.Registration Certificate No. of the Vehicle

c)Enrolment No. under the WB VAT Act 2003(if any)

No. Date

8.Total Value of Goods(details as per Annexure to 50 A)

9.Possible Entry location in W.B

192013116385983

Directorate of Commercial Taxes,West Bengal

30/11/2013 3.54 PM

31/12/2013

19743414048

19743414242

ASANSOL STEEL CASTINGS (P) LTD.

, SRIPUR VILLAGE ROAD, BURDWAN

District-BARDHAMAN

AACCA1575D

09802500118

09802500118

N.K.IRON INDUSTRIES

C-3 FOUNDRY NAGAR

AGRA

282006

UTTAR PRADESH

Bihar Assam Road Transport Corporation

Shadara chungi Agra

1084442.00

OTHERS

Road

Note a) Name of the District, if transport by roadb)Name of the railway station/port/airport,if transport by rail/sea/air

112 30/11/2013

Waybill Serial No.T1920130791837166

UP75H9008

713303

1

Name of the person signing the Waybill

Status of the person signing the Waybill [in relation to the importing dealer].

Signature

#Proprietor/Partner/Director/Authorised Person, etc1 of 2

THE WEST BENGAL VALUE ADDED TAX RULES, 2005

ANNEXURE TO WAYBILL IN FORM 50ADetails of Invoices / Tax Invoices / Cash Memos / Bills / Challans / Forwarding Notes and of goods in relationto Sl. No. 7 and Sl. No. 8 of Waybill in Form 50A

30/11/2013 4.16 PMOriginal/Duplicate

Printed On:

Valid upto

Date of generation of the waybill in Form

Office of issue

Waybill Key No.

Waybill Serial No

Directorate of Commercial Taxes, West Bengal

30/11/2013 3.54 PM

31/12/2013

192013116385983

Details of Invoice/tax invoice/cash memo/bill/challan/forwarding note etc. and description,quantity

and value of goods

T1920130791837166

Invoice/bill/challan/forwarding note etc. Name

Invoice Date

Quantity

Value ofGoodsUnit

Commodity

Nos of Packages

84 30/11/2013 750.00 1084442.00PIECES 750CAST IRONCASTING

Declaration-*I/We declare that the information furnished as above are correct to the best of my/our knowledge andbelief

SignatureName of the person signing the declaration

Status of the person signing the declaration

[In relation to the importing dealer]

2 of 2