FORM 403

(See Sub-Rule (1) of Rule 51)

(For Goods entering in to state from outside the state)

The Officer in Charge_____________________________ Sr. No. : 9000070202

(1) Place from which Goods are Dispatched : JAMMU Dist. : JAMMU & KASHMIR
(2) Place to which Goods are Dispatched : AHMEDABAD Dist : GUJARAT
(3) Details of Goods Invoice No : Date : 29-Jul-2017

(4) Consignor's Details ABHIJIT KUMAR State : JAMMU & KASHMIR

Name & Adress : FedEx Express, Hall No 1, Ground Floor, Jeevan State VAT No. :
Bhaw JAMMU-180001 JAMMU & KASHMIR
Date :

Telephone No. : 849394584 CST No. :

Fax No. : Date :

(5) Nature of Transaction i ) Inter State Sale

iii) Depot Transfer ii ) R. R. Endorsment

v) For Jobwork /Works Contract ¥ vi) Consignment to Branch/Agent

(6) Consignee's Details QARMATEK SERVICES PVT. LTD. State : GUJARAT

Name & Adress : 123/B-1, PHASE 1, NEAR PUSHPAK ESTATE, State VAT No. : 24073606986
AHMEDABAD-382445 GUJARAT
Date : 12-Jul-2011

Telephone No. : 08866096251 CST No. : 24573606986

Fax No. : Date : 12-Jul-2011

Consigned Value Rs. :

Sr No. Discription of Goods Commodity Code Unit Qty. Rate of Tax Value
System.Data.DataRowView 1.000 NA 4900

(7) Transporter Details : a) Name b) Address (9) Driver Details: a) Name b) Address
FT Id: TS000010609
c) Owner/ Partner's Name : c) Driving Licence No. :
d) Signature d) Licence issuing State : e) Signature
(8) Vehicle No. : L. R. No. : Date :

Place : JAMMU Signature :

Date : 29-Jul-2017
SEAL Designation :

FOR SALES TAX DEPARTMENT / CHECK POST

Entry No. Date Time Reason of abnormal stoppage Result if any

Date : Signature : Designation :