To,
.......................................................(* assessing authority )/ authorised officer),
....................................................... (name of *Charge /Division / Section / Circle / Checkpost.)
I, ...................................... (name ), ........................................ (status of the applicant ) carrying on business under the trade name of ........................................... holding certificate of registration No. ................................ do hereby apply under rule 110 for ....................................... (State number of forms) way bill in Form 50 required for the purpose of rule 100 / rule 103 / rule 104 of the West Bengal Value Added Tax Rules , 2005.
I declare that -
* (a) no way bill in Form 50 has been received by me on any previous occasion ,
* (b) way bill in Form 50 has been received by me on the last two occasions as follows :-
(i) .......................... (here state the total number of forms) forms bearing Serial No. (s) ..................... to .......................... on ............................... ( date ).
(ii) .......................... (here state the total number of forms) forms bearing Serial No. (s) ..................... to .......................... on ............................... ( date ).
*(c) the stock of way bill in Form 50 held by me on the date of application is ............................ ( total number ) bearing Serial No. (s) .............................
The particulars of import and of last four returns submitted are given below :
Please supply the way bills in Form 50 to *me/us/ ...................................... (specify full name ) who is hereby duly authorised to receive the said form and acknowledge the receipt thereof. The signature of authorised receipient is given below.
Attested signature of the receipient ...............................................
Signature ...........................................
Date ........................
Status ................................................
_____________________________________________________________________________________
*Strike out whichever is not applicable.