Government of Madhya Pradesh

"e-Form 49"

Commercial Tax Department

[See rule 70(3)]

Declaration

Form 49: I44B596

IN
Ujjain Circle-1

Issue Date and Time

08 April 2016 10:09 PM

Form Validity

Name and Address

PANCHMAHHAL DIST CO OP MILK PRODUCERS UNION LTD GODHRA,

Chandesari, ujjain, ujjain, Madhya Pradesh

Name and Address

ASHTAVINAYAKA TECHNOCRAFTS PRIVATE LIMITED

PLOT NO 388, GIDC, KATHWADA, AHMEDBADAD, GUJRAT
Gujarat

22 April 2016

Details of MP Dealer
TIN

23402305096

TIN

24575105543

Details of Form 49:

S.
Invoice No and Date
No

t
e:
lid
up 10 08to :09 AP
:2
R
P
2- M -20
AP
16
R20
16

Details of Other State Dealer

Destination

The PDCMPU Ltd.,

Dewas Road, Near
Maharaja Collage,
Gram Chandesari,
Ujjain MP

6, 08/04/2016

Goods Category

Machinery and machinery parts

Goods
Description

Total
Quantity/
Weight

Machine & Machinery

Parts

Total

Place from which goods dispatched

Total Value

1445400

1445400

AHMEDABAD

Carrier ( Transport company or owner of the vehicle etc )

Name and Address
Bilty No and Date

Vehicle Number

I as consignor declare that all the details given above are true and correct
Place :

Da

Date :

Signature and Name of authorized person

To be completed in the office of the checkpost ( Not required when computer generated printed e-gate pass is given)

Va

Designation

Iss

Seal and Signature

ue

Date and time of Entry/Exit of vehicle at check post

Date :