Original/Duplicate

THE WEST BENGAL VALUE ADDED TAX RULES, 2005 FORM 50A
Printed On: 17/01/2013 5.32 PM
Way bill for transport of consignment of goods despatched from Outside West Bengal to any place inside West Bengal

[See rule 110B read with rule 100A,rule 103A and rule 104A] Waybill Serial No. Waybill Key No. Office of issue Date of generation of the Waybill in form 50A Valid upto 192013014236030 T1920130535406220 Directorate of Commercial Taxes,West Bengal 17/01/2013 5.04 PM 17/02/2013

1.Name and Address of the Dealer/Person Importing the goods a)VAT RC No b)CST RC No c)Trade Name d)Address of principal place of Business 19601130083 19601130277 PIONEER INDUSTRIAL CORPORATION , 140A,S P MUKHERJEE R, OAD,CALCUTTA District-KOLKATA e)PIN f)PAN 700026 ADAPA2258D

2.Name and Address of the Dealer/Person from whom the goods are purchased/imported a)VAT RC No b)CST RC No c)Trade Name d)Address of principal place of Business SAUDI BASIC INDUSTRIES CORPORATION P.B.BOX 5101 RIYADH-11422 e)PIN f)PAN g)State of India/Union Territory of India/Country other than India 3.Mode of transport of goods in West Bengal 4.Registration Certificate No. of the Vehicle 5.Name and Address of the Transporter/Owner of the vehicle by which the goods are transported a)Name b)Address FOREIGN COUNTRY Sea SAUDI ARABIA 000000

c)Enrolment No. under the WB VAT Act 2003(if any) 6.Detail of Consignment Note/Railway Receipt/Airway Bill/Bill of Landing/ Bill of Entry or similar document No. R83647158 Date 25/12/2012 1

7.Total No. of Invoices/tax invoices/cash memos/bills/challans/forwarding notes(details as per Annexure to

8.Total Value of Goods(details as per Annexure to 50 A) 9.Possible Entry location in W.B

Note a) Name of the District, if transport by road b)Name of the railway station/port/airport,if transport by rail/sea/air

3099396.69 N S DOCK

Declaration-*I/We declare that the information furnished as above are correct to the best of my/our knowledge and belief.

Signature Name of the person signing the Waybill Status of the person signing the Waybill [in relation to the importing dealer]. #Proprietor/Partner/Director/Authorised Person, etc
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THE WEST BENGAL VALUE ADDED TAX RULES, 2005 ANNEXURE TO WAYBILL IN FORM 50A
Details of Invoices / Tax Invoices / Cash Memos / Bills / Challans / Forwarding Notes and of goods in relation to Sl. No. 7 and Sl. No. 8 of Waybill in Form 50A Original/Duplicate Printed On: Waybill Serial No Waybill Key No. Office of issue Date of generation of the waybill in Form Valid upto 192013014236030 T1920130535406220 Directorate of Commercial Taxes, West Bengal 17/01/2013 5.04 PM 17/02/2013 17/01/2013 5.32 PM

Details of Invoice/tax invoice/cash memo/bill/challan/forwarding note etc. and description,quantity and value of goods

Invoice/bill/challan/for Invoice Date warding note etc.

100553771

Commodity Name Quantity

33.00

Unit
METRI C TON

Nos of Packages
1320 BAGS

Value of Goods
3099396.69

20/12/2012 PLASTIC GRANULE, PLASTIC POWDER.

Declaration-*I/We declare that the information furnished as above are correct to the best of my/our knowledge and belief Signature Name of the person signing the declaration Status of the person signing the declaration [In relation to the importing dealer]
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