The Assam Value Added Tax Rules, 2005. Forms
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THE ASSAM VALUE ADDED TAX RULES, 2005

FORM-61

[See Rule 41(9)(ii)]

DELIVERY NOTE

Counterfoil/Original/Duplicate

Book No. .....................................................	Serial No .................................
Date of issue ...............................................
To whom issued ..........................................
(Name and address of the dealer)

To,

The Superintendent of Taxes,

..............................................Check post

I/We hereby declare that the following consignment of . . . . . . . . . . . . . . . . is being imported into Assam..............................................

1	Name and address of the consignor ..........................................................................
2	Name and address of the consignee ..........................................................................
3	Place of despatch ......................................................................................................
4	Name of the check post through which the goods will be transported ...................................................................................................................................
5	Destination ...............................................................................................................
6	Description of consignments ....................................................................................
7	Quality ......................................................................................................................
8	Weight ......................................................................................................................
9	(a) Value ................................................................(b) Freight ..................................
10	Consignor's Invoice No. and date ...............................................................................
11	(i) Name of transporter ...............................................................................................
	(ii) Consignment No ........................................and date .............................................
	(iii) Registration No. of the vehicle ............................................................................
	(iv) Name of the owner of vehicle ...............................................................................
	(v) Date of interception at the Checkpost ....................................................................
12	Remarks (if any) ...........................................................................................................

I/We hereby declare that I/We am/are registered under the Assam Value Added Tax Act, 2003 holding Registration Certificate No.....................and the above statements are true to the best of my/our knowledge and belief.

I/We also undertake to duly account for the disposal of the above goods when imported and to pay tax on the sales thereof according to the provisions of the said Act and the Rules made thereunder.

	Name of the Consignee in full ..........................................
	Signature and status of the applicant .................................

Office of the issue

Seal of issue

Signature of the Prescribed Authority

N.B.: The delivery Note in Triplicate must be obtained from the Prescribed Authority concerned on payment as may be notified.

This Delivery Note will remain valid for 180 days from the date of issue by the prescribed authority.