The Uttar Pradesh Value Added Tax Rules, 2008, FORMS
-

Body

FORM - XVII Omitted w.e.f. 15-12-2016

Department of Commercial Taxes, Government of Uttar Pradesh

[See sub-rule (9)(a) of Rule-38 of the UPVAT Rules, 2007]

Declaration by the consigner to be obtained by a transporter, carrier or forwarding agent, railway container contractor

Declaration No.............................................

Date :

Name & Address of Consigner

Phone No. if any

T.I.N.

w.e.f.

Name & Address of Consignee

Phone No. if any

T.I.N.

w.e.f.

Sl.No.	Detail of goods received for transportation	Number	Date
1.	No. and date of tax invoice/sale invoice/bill/cash memo/Purchase Invoice/Transfer Challan-
2.	Description of goods
3.	No. of packets / bags / case
4.	Weight / measurement
5.	Value of goods
6.	Goods Receipt no.& date

Name and Address of transporter, carrier or forwarding agent railway container contractor.

Phone No. if any

Service Provider Number

w.e.f.

I..............................................................s/o,d/o,w/o.................................................................................,
(status) ...................... of the business, do hereby declare that particulars furnished above are true to the best of my knowledge.

	Signature, Name & Status
	of the Authorized Person
	Seal of Consigner
	Date