The Chhattisgarh Value Added Tax Rules, 2006. - FORMS
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FORM 59

[See rule 69(3)]

DECLARATION

Under section 58 of the Chhattisgarh Value Added Tax Act, 2005

Book No.______ S.No._______ Date of issue___________

Name and address of the dealer to Seal of issuing authority whom issued__________

Registration Certificate No.

under the Chhattisgarh Value Added Tax Act, 2005

1.	(a) Name and complete address of the consignor or the consignee, as the case may be
2.	Place from which the goods dispatched.
3.	Consignor's invoice No. and date.
4.	Destination (including District)
5.	Brief description of goods
6.	Total quantity and total weight
7.	Total value
8.	(a) Name and address of the carrier (transport company or owner of the vehicle etc.) and vehicle number.
	(b) Bilty/L.R. No. and date

I, ____________ declare that to the best of my knowledge and belief the above statements are true and correct.

Place
Date	Seal and signature of the consignor of the goods

(To be completed in the office of the check post)

Time of arrival of the vehicle at the check post________

Date

Time of departure of the vehicle from the check post___________

Reasons for abnormal detention of the vehicle at the check post______________

Seal
Date _________	Signature and designation of the officer