The Jharkhand Value Added Tax Forms , 2005
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FORM JVAT 507

GOVERNMENT OF JHARKHAND

COMMERCIAL TAXES DEPARTMENT

[See Rule Rule 44(1)(b)]

Form of Declaration to be issued by the Principal to his Agent or Branches/Unit

Serial Number: ____________________________

Original/Duplicate

1.	Name of the Dealer (Principal)	_____________________________________
2.	Registration No. (TIN)	_____________________________________
3.	Address	Building Name/Number	_________________________
		Area/Road	_________________________
		Locality/Market	_________________________
		Pin Code	_________________________
		Telephone Number(s)	_________________________
4.	Name of the Agent/Branches/Units _____________________________________
5.	Registration No. (TIN) _____________________________________
6.	Address	Building Name/Number	_________________________
		Area/Road	_________________________
		Locality/Market	_________________________
		Pin Code	_________________________
		Telephone Number(s)	_________________________
7.	Date of dispatch of goods by the principal
8.	Description of the goods dispatched:

(Attach all challans with the dispatch note)

Challan No.	Challan date	Name of commodity	Quantity/Weight	Value of goods

9.	Name of the owner of the goods vehicle or other vehicle by which goods are dispatched		______________________________
10.	If the Principal is transporting the goods after purchasing them:
11.	Name of the Seller		______________________________
12.	Registration No. (TIN)		______________________________
13.	Address	Building Name/Number	_________________________
		Area/Road	_________________________
		Locality/Market	_________________________
		Telephone Number(s)	_________________________

Verification

I certify that the information given in this form and its attachments (if any) is true and correct to the best of my knowledge and belief and nothing has been concealed

Signature

Name

Designation

Date

Place