Form BHR-3

Form of Declaration under the Bihar Value Added Tax Act, 2005 for transportation of goods within the State of Bihar

(in case of transportation of goods, within the State of Bihar, by or on behalf of a person other than a dealer registered under the Act) [See rule 41(5)]

1. Name of Consignor:-

2. Complete Address of the Consignor:-

3. Cell phone number of the Consignor:-

4. Name of the Consignee:-

5. Complete Address of the Consignee:-

6. Taxpayer Identification No. of the Consignee:-

7. Cell phone number of the Consignee:-

8. Place of Dispatch:-

9. Destination of Consignment:-

10. Document issued by Seller:-

(a) Number:

(b) Date:

11. Document issued by Transporter:

(a) Number:

(b) Date :

12. Description of Consignment:-

13. Purpose (select from list):-

(a) Resale

(b) For use as Plant and Machinery in manufacture of Goods

(c) For use in execution of works contract

14. Mode of Transport (Vehicle No.):-

15. Name of the transport/courier agency:

I/ We hereby declare that the above statements are correct and complete to the best of my/our knowledge and belief.