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Original

Duplicate
Triplicate
Quadruplicate
FORMJJ
DeliveryNote
[Seerule15(3),15(18),15(19),15(20),15(21)]
(forsales/stocktransfer/workscontract/labour)

TIN

Asst.Year

1. (a)Nameandaddressoftheconsignor
(b)TIN
(c)CSTRegistrationNo.
2. (a)Nameandaddressoftheconsignee/branch/
agent
(b)TIN,ifany.
(c)CSTRegistrationNo.
3. Address
(i)fromwhichgoodsareconsigned.
(ii)towhichgoodsareconsigned
4.Descriptionofgoodsconsigned
(a)Nameofthegoods.
(b)Quantityorweight
(c)Valueofthegoods
5.Purposeoftransport
(a) forsale/purchase
(b) forshipment
(c) transfertobranch/headoffice/Consignmentagent
(d) forexecutionofworkscontract
(e) forlabourwork/processing
6.Towhomdeliveredfortransportandvehicleno.,ifany/
7.Remarks,ifany.

I/Wecertifythattothebestofmy/ourknowledgetheparticularsaretrue,correctand
complete.

Nameandsignatureofthepersonto
whomthegoodsweredeliveredfor
transportingwithstatusofpersonsigning.

Nameandsignatureoftheconsignor/
hisemployee/hisrepresentative

Place:
Date:
**Note(1)Originaltobefurnishedtotheofficerinchargeofthefirstcheckpostorbarrier,the
secondcopytosuchofficerinthelastcheckpostorbarrierandthethirdcopyshallberetainedby
theownerorotherpersoninchargeofthegoodsvehicleorboat.
(2)Theentriesinthisformshouldbemadeininkorbycopyingpencilusingdoubleside
carbonpaper.Inthecaseofdeliverynotesissuedinrespectofgoodsintendedtobetransferredto
aplaceoutsidetheStateofTamilNaduentriesshouldbemadeinEnglish. Inothercasesof
transportsuchentriesmaybemadeeitherinEnglishorintheofficialregionallanguageofthe
State,namely,Tamil.
(3)Anycorrectionsmadeintheformshouldbedulyattestedbythepersonsigningthe
form.
**(4)Theoriginal,duplicate,triplicateandquadruplicatecopiesaretobeprintedinwhite,
blue,redandyellowcoloursrespectivelyforeasyidentification.

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