GOVERNMENT OF TAMILNADU

COMMERCIAL TAXES DEPARTMENT 90405176303952

FORM JJ / Advance Way Bill

Delivery Note
(This Form be used for sales/stock transfer/works contract/labour work)
[See Rules 15(3), 15(14), 15(18), 15(20), 15(21)]
If you have any query regarding any of the questions consult the nearest Assessment Circle.

Date: 04/05/2017 03:52:51 PM

Form Number FJJ04051700015860266

Declaration Type Within State Movement
Purpose of Transport Sent for Labour work/processing

Section A - Details of Consignor

Taxpayer Identification Number 33223542459

Name EMKAY STEEL AGENCIES
Address State
TIRUCHIRAPPALLI Tamil Nadu

Section B - Details of Consignee

Taxpayer Identification Number 33223542459

Name EMKAY STEEL AGENCIES
Address State
TIRUCHIRAPPALLI Tamil Nadu

Section C - Invoice and Goods Details

Invoice Invoice Date Description of Goods/Commodity Quantity Units Basic Rate of Value Total Value
Number Price(Rs.) Tax(%) Added of Goods
Tax/Central (Rs.)
Sales
Tax(Rs.)
DECLARED GOODS AS SPECIFIED IN SECTION 14 6010.000 Ton 288500.00 0.00 0.00 288500.00
OF THE CST ACT, 1956, OTHER THAN THOSE
SPEC. IN ANY SCH - GP & CR COILS

Section D - Transporter and Vehicle Details

Mode of Transport By Road

Transport Vehicle Number TN57M5112

Section E - Other Details

Address from which goods are consigned

TIN (In case of job work,this may be Address State Pin
diff)
33223542459 No.40A, Subjail Road,Trichy Tamil Nadu 620008

Address To which goods are consigned

TIN (In case of job work,this may be Address State Pin
diff)
NA PGR Industries, Coimbatore Tamil Nadu 641035

Section F - Declaration and Certification

I/We_______________certify that to the best of my knowledge the particulars are true, correct and complete.

Signature of consignor/employee/representive Signature of the person to whom goods were delivered for transporting
Date(Day/Month/Year) Status