[See sub-rule (3) of rule 79]
IN TRIPLICATE
2. Consigner of goods
(actual date / expected date)
7. Consignee of goods
8. Consigner despatching goods for [(Tick) Mark in the appropriate box]
Works contract
reason, agent (please specify)
9. Details of Invoice / Challan / Other Document(s)
(With seal & Signature)
13. Signature of the Dealer of Orissa
(To whom way bill is issued / who generates the waybill from the portal of the Department)