The challan/delivery challan as referred to in sub-rule of rule 67 shall contain the following particulars, namely:

(a) the words 'challan / delivery challan' in bold letter at the top,

(b) the name, address and registration certificate number of the selling registered dealer,

(c) the name and address of the purchasing dealer and registration certificate number, if registered under the Act,

(d) in case, the consignment is in course of export out of the territory of India, the name, address, registration certificate number, if any, of the purchasing dealer or foreign buyer and the type of statutory form, if any,

(e) an individual serialized number and the date of issue,

(f) description, quantity/volume and value of goods under consignment and the nature of transaction,

(g) signature of the dealer consigning the goods or his manager or any other employee or agent, duly authorized by him, and

(h) the name and address of the printer, if any, and first and last serial number of challan/delivery challan printed and supplied by him to the dealer.