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FORMXXXVIII
DepartmentofCommercialTaxes,GovernmentofUttarPradesh
[Seerule54oftheUPVATRules,2008]
FormofDeclarationforimport
OriginalCopy
Form38SerialNo
DateofIssue
AssessmentOffice
TIN
NameofDealer
AddressofDealer
1.DescriptionofGoods
2.Weight/Measure
3.Quantity
1607ES28926900413622
22/07/2016
ShamliSector2,AC
09773201398
ThiseSancharanNumberisvalidupto25/07/2016
Date(w.e.f)
M/SA.M.LIFECARE
NOKUHWAROAD,SHAMLI
Medicines
180.00Kilograms
7Box
11/11/2007
4.ValueinFigure
5.ValueinWords
6.Bill/cashmemo/challan/taxinvoicenumber&date
26996.00
RupeesTwentySixThousandNineHundredNinetySixOnly
(AB0296,22/07/2016)
7.GoodsDestinationPlace
8.NameandAddressofseller/consignor
9.TINofseller/consignor
SHAMLI
AMBLEBIOTECHKAITHALHARYANA
06742111723
I,,theauthorizedsignatoryoftheabovenameddealerdohereby
declarethatthegoodsnotedabovearebeingimported/received/broughtbytheaforesaiddealer.
ThisVishishtaSancharanNumber/FormXXXVIIIisonlinegeneratedandassuchdoesnotrequireanysignatureof
importer/seller.
Signatureofauthorizedsignatory
1.Name&addressoftheTransporter/carrieretc.
2.ServiceProviderno.ofthecarrier,ifany
shivalika
3.Carrier/Truckno.
4.Name&addressofDriver
5.DrivingLicenseNo.
6.Signatureofthevehicledriver.
.....
DemandNo:D1607800369065(160700509730) Single(Original)
PrintedOn:22/07/201611:49:14
1/2
7/22/2016
FORMXXXVIII
DepartmentofCommercialTaxes,GovernmentofUttarPradesh
[Seerule54oftheUPVATRules,2008]
FormofDeclarationforimport
SecondCopy
Form38SerialNo
1607ES28926900413622
DateofIssue
AssessmentOffice
22/07/2016
ShamliSector2,AC
TIN
09773201398
ThiseSancharanNumberisvalidupto25/07/2016
Date(w.e.f)
11/11/2007
NameofDealer
AddressofDealer
M/SA.M.LIFECARE
NOKUHWAROAD,SHAMLI
1.DescriptionofGoods
Medicines
2.Weight/Measure
180.00Kilograms
3.Quantity
4.ValueinFigure
5.ValueinWords
7Box
26996.00
RupeesTwentySixThousandNineHundredNinetySixOnly
6.Bill/cashmemo/challan/taxinvoicenumber&date
7.GoodsDestinationPlace
8.NameandAddressofseller/consignor
(AB0296,22/07/2016)
SHAMLI
AMBLEBIOTECHKAITHALHARYANA
9.TINofseller/consignor
06742111723
I,,theauthorizedsignatoryoftheabovenameddealerdohereby
declarethatthegoodsnotedabovearebeingimported/received/broughtbytheaforesaiddealer.
ThisVishishtaSancharanNumber/FormXXXVIIIisonlinegeneratedandassuchdoesnotrequireanysignatureof
importer/seller.
Signatureofauthorizedsignatory
1.Name&addressoftheTransporter/carrieretc.
2.ServiceProviderno.ofthecarrier,ifany
3.Carrier/Truckno.
shivalika
.....
4.Name&addressofDriver
5.DrivingLicenseNo.
6.Signatureofthevehicledriver.
DemandNo:D1607800369065(160700509730) Single(Second)
PrintedOn:22/07/201611:49:14
2/2