Government of Karnataka

(Department of Commercial Taxes) e-SUGAM FORM

See sub Section(2-A) of Section 53 read with Rule 157(1)(a)Sl.No:51361099146

Date & Time of Printing: 27/04/2015 09:21 AM

Office of LVO of the Dealer Uploading LVO-090

I

(a) Name and address of the Dealer Uploading

(b) TIN(c) Date of Uploading the details(d) Date of Transportation of Goods

NIRMALA CONSTRUCTIONS

29880088671

27/04/2015 09:21 AM

27/04/2015

II

Place:

(i) From(ii) To(iii) Transit Place (if any)

MYSORE

BANGALORE

III

Description of the goods:

(i) Name of goods consigned(ii) Quantity or weight(iii) Taxable Value(iv) VAT/CST Collected(iv) Other Amount if any(v) Total Amount

MACHINERYAND PARTS - HDD MACHINE SR II

1 NOS

16000000

0

0

16000000

IV

(i) Name and address of the owner of the goods vehicle or vehicle by which the goods are consigned

(ii) Registration number of the goods vehicle or vessel

(iii) GC/LR No.(iv) GC/LR Date(v) Transporter Mobile No (if any).

KA04 D 5728

V Category of Transaction Within State For Jobwork/Return afterJobwork/Line Sale/Stock Tansfer/Others

VI

Details of consignor and consignee as per Category:

(i) TIN of Consignor(ii) Name and address of Consignor(iii) TIN of Consignee(iv) Name and address of Consignee(v) Document No.(vi) Document Date

29880088671

NIRMALA CONSTRUCTIONS

29880088671

NIRMALA CONSTRUCTIONS

440 - Lab. Chg/Jobwork Voucher

27/04/2015