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IN
Jabalpur Circle-3
Issue Date and Time 21 February 2017 5:48 PM Form Validity 07 March 2017
Details of MP Dealer
TIN 23696000976 Name and Address M/S. KOHLI AUTOMOBILES,
2075, BUS STAND, WRIGHT TOWN, JABALPUR, JABALPUR, Madhya Pradesh
17
Punjab
7- M -20
S. Invoice No and Date Destination Goods Category Goods Total Total Value
No Description Quantity/
17
Weight
1 5675, 16/02/2017 Jabalpur Tractor, accessories and parts thereof 20 44251
:0 P B
20
Total 44251
to 48 -FE
Place from which goods dispatched Ludhiana
R-
Carrier ( Transport company or owner of the vehicle etc )
Name and Address
Bilty No and Date Vehicle Number
up 5: 21
MA
I as consignor declare that all the details given above are true and correct
Place :
:
te
Designation
Iss
lid
Va