Government of Karnataka

(Department of Commercial Taxes)

e-SUGAM FORM
See sub Section(2-A) of Section 53 read with Rule 157(1)(a)
Sl.No:51961478123
Office of LVO of the Dealer Uploading
(a) Name and address of the Dealer Uploading

LVO-031
EXECUTIVE ENGINEER TL & SS DIVISION
DAVANGERE

(b) TIN
I

29670472276
(c) Date of Uploading the details
21/05/2015 11:07 AM
(d) Date of Transportation of Goods
21/05/2015
Place:
(i) From

DAVANGERE

(ii) To

JAYSINGPUR, MAHARASHTRA

II
(iii) Transit Place (if any)
Description of the goods:
(i) Name of goods consigned

ELECTRICAL GOODS - SHREEM MAKE SINGLE

PHASE CAPACITOR UNIT 484 KVAR

(ii) Quantity or weight

01 NO
III

(iii) Taxable Value

58829
(iv) VAT/CST Collected
0
(iv) Other Amount if any
0
(v) Total Amount
58829
(i) Name and address of the owner of the goods
vehicle or vehicle by which the goods are
consigned

IV

(ii) Registration number of the goods vehicle or

vessel
(iii) GC/LR No.
(iv) GC/LR Date

(v) Transporter Mobile No (if any).

Category of Transaction

Inter State For Jobwork/Return after Jobwork/Line

Sale/Stock Tansfer/Others

Details of consignor and consignee as per Category:

(i) TIN of Consignor

27960410021

(ii) Name and address of Consignor

SHREEM ELECTRIC LTD, JAYSINGHPUR,

KOLHAPUR

(iii) TIN of Consignee

VI

29670472276
(iv) Name and address of Consignee
(v) Document No.

EXECUTIVE ENGINEER TL & SS DIVISION

DAVANGERE

(vi) Document Date

929 32 - Lab. Chg/Jobwork Voucher

21/05/2015

Date & Time of Printing: 21/05/2015 11:07 AM