THE ASSAM VALUE ADDED TAX RULES, 2005

FORM-66

[See Rule 41(12)]

DELIVERY PERMIT

To

The Prescribed Authority,

....................

I/We hereby declare that the following consignment of ........ is being imported into Assam by Rail /Air /Steamer and apply for a permit to transport the same from the railway station/air port /steamer station/post office mentioned below:-

(1) Name and address of the seller from whom purchased :

(2) Name and address of the consignee :

(3) Place of despatch :

(4) Name of the railway station/steamer station/post office/air port from where delivery will be taken :

(5) Destination :

(6) Description of consignments :

(7) Quantity :

(8) Weight :

(9) Value :

(10) Consignor's Invoice No. and date :

(11) Railway receipt or Bill of Lading or Air Note No.

(12) Remarks (if any) :

I/We hereby declare that I/We am/are registered under the Assam Value Added Tax Act, 2003 holding registration certificate No. ............ and the above statements are true to the best of my/our knowledge and belief.

I/We also undertake to duly account for to you the disposal of the above goods when imported and to pay tax on the sales thereof according to the provisions of the said Act and the Rules made thereunder.

Name of the dealer in full .......................

Address .........................

Signature and status of the applicant ................

PERMIT

No................

I hereby permit to take delivery or to transport the consignment detailed above.

Signature of Prescribed Authority