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:61789306915
Office of LVO of the Dealer Uploading LVO-031
(a) Name and address of the Dealer Uploading BATA INDIA LIMITED
(b) TIN 29810098361
I
(c) Date of Uploading the details 28/12/2015 10:39 PM
(d) Date of Transportation of Goods 28/12/2015
Place:
(i) From BATA SHOE STORE HENNUR CROSS
II BANGALORE
(ii) To
BATA INDIA LTD RDC PEENYA BANGALORE
(iii) Transit Place (if any)
Description of the goods:
(i) Name of goods consigned FOOTWEAR
(ii) Quantity or weight 18PAIRS
III (iii) Taxable Value 28882
(iv) VAT/CST Collected 0
(iv) Other Amount if any 0
(v) Total Amount 28882
(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
IV
(iii) GC/LR No.
(iv) GC/LR Date
(v) Transporter Mobile No (if any).
V Category of Transaction Within State Stock Tansfer(Despatch)
Details of consignor and consignee as per Category:
(i) TIN of Consignor 29810098361
(ii) Name and address of Consignor BATA INDIA LIMITED
VI (iii) TIN of Consignee 29810098361
(iv) Name and address of Consignee BATA INDIA LIMITED
(v) Document No. CLM1500016 - Stock Transfer Memo
(vi) Document Date 28/12/2015
Date & Time of Printing: 28/12/2015 10:39 PM
