ORDERED VIA: PREPAID

No Collection HYD/HTC
Weight: 500 gms Invoice

SHIP TO: Invoice Number: 140757/2016-17/4 Invoice Date : 13-01-2017

KISHAN JUPALLY Shipped From
9TH FLOOR, 3RD BLOCK
MY HOME HUB , BESIDE CYBER TOWERS MADHAPUR
CITY: HYDERABAD Kanta Rani Contractor VAT/ TIN No: 09376902534
STATE: TELANGANA 29,roshanpur,dorly PAC roorkee road,meerut PAN: BMWPG6528G
PIN: 500081 CST No: 09376902534
MOBILE: 9701900356 meerut cantt, Uttar Pradesh - 250110

BLUE DART - PREPAID

Shipping Address Billing Address

*69887147540* AWB #: 69887147540

Kishan Jupally
9th floor, 3rd block
My Home Hub , beside Cyber towers
Madhapur
Kishan Jupally
9th floor, 3rd block
My Home Hub , beside Cyber towers
Madhapur
PAYTM ITEM NAME QTY VALUE SHIPPING FINAL
Hyderabad, Telangana- 500081 Hyderabad, Telangana- 500081
SKU CHARGE AMOUNT

SG_BL (Item # 1 299 15 314

2720529926) Sg DESCRIPTION QUANTITY PRICE (INR) TAX TYPE TAX TAX AMOUNT TOTAL AMOUNT
Black Belt (Size = RATE(%) (INR) (INR)
32) (size = 32)
Sg Black Belt (Size = 32) 1 261.14 CST 14.5 37.86 299

Total 1 299 15 314

PAYTM ORDER REFERENCE TOTAL 1 261.14 37.86 299

*1948453195* SHIPMENT # 1948453195

Total Amount in Words: Two Hundred Ninety Nine Rupees Only

(For Kanta Rani Contractor)

ORDER # 2564159169
IB : Form X or Form 600 Required DECLARATION:
We declare that this invoice shows the actual price of the goods described above and that all particulars are true and correct.The
If undelivered, return to:
goods sold are intended for end user consumption and not for resale.
KANTA RANI CONTRACTOR CUSTOMER ACKNOWLEDGEMENT:
(140757) I KISHAN JUPALLY confirm that the said products are being purchased for my internal/personal consumption and not for re-sale.

29,roshanpur,dorly PAC roorkee road,

meerut Paytm Order ID :2564159169
CITY: meerut cantt Any issue or problem,
STATE: Uttar Pradesh we are available 24 X 7
PIN: 250110 for you at paytm.com/care Registered Address: NH-108,pallavpuram phase-II meerut
PHONE: 0120-3062244 meerut cantt, Uttar Pradesh - 250110
SELLER TIN: 09376902534
(This is computer generated receipt and does not require physical signature.)
Return Path: MDP/MDP 250110
 FORM X or FORM 600
FORM OF WAY BILL
[See Rule 33 (1)(d) & 55(1) & (4)]

1. Office of issue Date Month Year

2. Date of issue of Way Bill by consignor

3. Name and address of the Dealer/Person Consigning the Registration Number

goods

Name: Kanta Rani Contractor TIN/GRN: 09376902534

Address: NH108pallavpuram phaseII meerut State: Uttar Pradesh

4. Full Address of Place (a) From which consigned (b) to which consigned.

Name: Kanta Rani Contractor Name: Kishan Jupally

Address: NH108pallavpuram phaseII meerut Address: Kishan Jupally,9th Floor, 3rd Block,my
Home Hub , Beside Cyber Towers
Madhapur,hyderabad, Telangana- 500081

5. If the consignor is transporting goods:

(a) In pursuance of sale for purpose of delivery to the buyer ; or
(b) After purchasing them; or
(c) From one of the shops or godown to an agent for sale:
(d) From shop or godown to another shop or godown for purpose of storage or sale; or
(e) To his principal, having purchased them on his behalf ; or
(f) To his agent for sale on consignment basis
(Mark " " whichever is applicable)

THE NAME AND ADDRESS OF THE DEALER/PERSON TO WHOM THE GOODS ARE
CONSIGNED OR FROM WHOM GOODS WERE PURCHASED

(Buyer or self or Agent or Principal) Registration Number

Name: KISHAN JUPALLY TIN/GRN:

Address: Kishan Jupally,9th Floor, 3rd Block,my State: TELANGANA
Home Hub , Beside Cyber Towers
Madhapur,hyderabad, Telangana- 500081
6. Description, quantity and value of goods.

Sl.No Commodity Invoice No./Date Quantity Value of Goods

1. Sg Black Belt (Size = 32) 140757/2016-17/4/ 1 261.14

13-01-2017
7. Name and address of the owner of the goods vehicle or vessel by which the goods are consigned
Vehicle/Vessel Number
Name:
Address:

Declaration:
I / We certify that to the best of my / our knowledge the particulars furnished here are true and correct.
Signature of the Consignor