The Chhattisgarh Value Added Tax Rules, 2006. - FORMS
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FORM 61

[See rule 71(3)]

Statement showing the particulars of goods transported under section 58 of the Chhattisgarh Value Added Tax Act, 2005

To,

the____________(Designation of the officer)

______________(Address)

With reference to your requisition No._______ dated_______

1, _______________ Proprietor/Manager/Partner/Director of Transport company Society/firm/Proprietor concern known as_________ owning vehicle No.________ whose office is situated at _____________ (hereby, furnish the following particulars the goods transported.

(1)	Details of the vehicle with registration No.
(2)	Name and address of the driver of the vehicle
(3)	Full name and address with registration certificate No. under the Chhattisgarh Value Added Tax Act, 2005, if any of the dealer on whose behalf the goods are consigned.
(4)	Full name and address of the person actually consigning the goods if he is a person other than the dealer mentioned in (iii) above.
(5)	Full name and address with the registration Certificate No. under the Chhattisgarh Value Added Tax Act, 2005,
	if and of the dealer on whose behalf the goods are actually consigned.
(6)	Full name and address of the person taking delivery of the goods.
(7)	Name and address of the person incharge of the goods.
(8)	Place (with district) from which goods dispatched.
(9)	Destination (with district)
(10)	Description of goods
(11)	Quantity or weight
(12)	Value of goods
(13)	Consignor's invoice No. and date.

I hereby declare that what is stated above is true to the best of my knowledge and belief.

Place
Date	Signature and designation