THE WEST BENGAL VALUE ADDED TAX RULES, 2005

FORM 53

Application for way bill in Form 51 for transport of goods form any place in West Bengal to any place outside West Bengal by registered dealers

[See *rule 110, read with rule 108]

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 51 required for the purpose of rule 108 of the West Bengal Value Added Tax Rules , 2005.

I declare that -

* (a) no way bill in Form 51 has been received by me on any previous occasion ,

* (b) way bill in Form 51 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 51 held by me on the date of application is ............................ ( total number ) bearing Serial No. (s) .............................

Please supply the way bills in Form 51 to *me/us/ ...................................... (specify full name ) who is hereby duly authorised to receive the said form and acknowledge the receipt thereof. The attested signature of the authorised receipient is attested below .

Attested signature of the receipient ...............................................

Signature ...........................................

Date ........................

Status .................................................

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*Strike out whichever is not applicable