DECLARATION FORM

Consignment No: _____________________________ Date: ______________________

Consignor Details:
Name: _______________________________________
GST Registered: Yes If Yes, GST No: __________________________
No We, M/s _______________________________, hereby declare and confirm that we
are not liable to register under Section 22 or Section 24 of the Central GST Act, 2017
or under the corresponding provisions of the applicable State GST Act. (Stamp)
Consignee Details:
Name: _____________________________________ Place of Delivery: ________________________
GST Registered: Yes If Yes, GST No: ___________________________________
No We, M/s ______________________________(‘consignor’), hereby declare to the best
of our knowledge that M/s _______________________________ (‘Consignee’) are
not liable to register under Section 22 or Section 24 of the Central GST Act, 2017 or
under the corresponding provisions of the applicable State GST Act.

Content: ________________________________________________________________________________________
If Consignor or Consignee is GST Registered, mention HSN Code : ____________________________________________

Reason for Transportation: ________________________________________

If this consignment is of commercial nature: Yes No
Value of Consignment :( (Irrespective of the commercial/Non-commercial nature of consignment)
Rs. (Rupees_________________________________________________________________)

Invoice: Yes If Yes, Invoice No: __________________________

No
Challan: Yes If Yes, Challan No: ___________________________
No

The above is true to the best of my knowledge and if found false, I/we will only be responsible for all cost and
consequences arising out of this declaration.

___________________ ______________________________________
Date Signature of the Consignor

Address: ______________________________________

______________________________________