ORDERED ON:

PREPAID
OD\BBH\BSR
Weight: 50 gms
F3 Tax invoice/Bill of Supply/Cash memo
www.PaytmMall.com Number: 24B0088466100021 Date: 05-08-2018 PaytmMall Order Id: 5735009365

ECOM EXPRESS - PREPAID Sold By: STREETKART RETAILS PVT LTD

WALL STREET-2, 703/A, NR.ORIENT CLUB, NR.

*255376791* AWB #: 255376791

RAILWAY CROSSING, ELLISBRIDGE, Ahmedabad,
Gujarat, 380006
Ahmedabad, Gujarat - 380006
PAN: AAZCS7567E
SHIP TO: GSTIN: 24AAZCS7567E1ZN
SUMIT DEY
Shipping Address: SUMIT DEY Billing Address: SUMIT DEY
NEAR DISTRICT VETERINARY HOSPITAL
NEAR DISTRICT VETERINARY HOSPITAL NEAR DISTRICT VETERINARY HOSPITAL
NAYABAZAR,RANIPATNA
CITY: BALASORE NAYABAZAR,RANIPATNA NAYABAZAR,RANIPATNA
STATE: ODISHA BALASORE,ODISHA-756001 BALASORE,ODISHA-756001
PIN: 756001 Place of supply : ODISHA (21)
MOBILE: 7008316018

OB : FORM 402 Required

*4195602246*

If undelivered, return to: ITEM QTY. PRICE (INR) TAX RATE & TYPE TAX AMOUNT TOTAL AMOUNT
STREETKART RETAILS PVT LTD (INR) (INR)
SHIPMENT # 4195602246

(884661)
ORDER # 5735009365

WALL STREET-2, 703/A, NR.ORIENT CLUB, NR. Streetkart Pink Bow Bikini Panty 1 237.14 5% IGST 11.86 249
RAILWAY CROSSING, ELLISBRIDGE, Ahmedabad,
Gujarat, 380006 Hipster Thongs Underwear
CITY: Ahmedabad Underpants (Size = free size)
STATE: Gujarat HSN Code :6108
PIN: 380006
PHONE: 9643-979797 STRK 5004
GSTIN: 24AAZCS7567E1ZN

Grand Total 1 237.14 11.86 249

Total Amount in Words: Two Hundred Forty Nine Rupees Only

Declaration:
We declare that this invoice shows the actual price of the goods * This is a computer generated invoice and does not require a
described above and that all particulars are true and correct. The goods physical signature
sold are intended for end user consumption and not for resale.

Customer Acknowledgement:
I SUMIT DEY confirm that the said products are being purchased for my internal/personal consumption and not for re-sale.
 FORM 402

(See rule 51)

Declaration under section 68 of the Gujarat Value Added Tax Act, 2003

(For movement of goods within the State or goods moving outside the State)

To,

The officer in charge

Check post .......

(1) Place from which goods are dispatched < 703A WALL STREET2 NRORIENT CLUB NR
RAILWAY CROSSING ELLISBRIDGE Ahmedabad Gujarat 380006 > District _______________
(2) Place to which goods are dispatched < Near District Veterinary Hospital,nayabazar,ranipatna,
balasore, Odisha- 756001 > District ___________
(3) Details of goods invoice No < 1 > Date < 05-08-2018 >
(4) Consignor s details :

Name Streetkart Retails Pvt Ltd Registration

Certificate No
Address 703a Wall Street2 Nrorient Club Nr Date
Railway Crossing Ellisbridge Ahmedabad
Gujarat 380006
Telephone 9099024152 Cst Registration
No.
Fax No. Date

(5) Nature of Transaction :

1: Inter state sale 2: Transfer of documents of title
3: Depot Transfer 4: Consignment to Branch/Agent
5: For Job works/Works contract
6: Any Other

(6) Consignee s details :-

Name Sumit Dey State Odisha

Address Near District Veterinary Hospital, Registration
nayabazar,ranipatna,balasore, Odisha- Certificate No
756001
Date
Telephone 7008316018 Cst Registration
No.
Fax No. Date

Consigned Value Rs. < 249 >

Sr. No. Description Of Goods Commodity Unit Quantity Rate Of Tax Value
Code
1 Streetkart Pink Bow Bikini Panty 1 0 249
Hipster Thongs Underwear
Underpants (Size = Free Size)
(7) Transporter s Details : (a) Name

(b) Address

(c) Owner/ Partner s Name

(8) Vehicle No ____________________ L.R.No. ____________________ Date _________________

(9) Driver s Details (a) Name

(b) Address

(c) Driving License No.

(d) License issuing State

(e) Driver s Signature

(10) Name of the Address of person in charge of goods _________________________

Seal

Place : _____________________ Signature :___________________

Date : _____________________ Designation : ________________

For Commercial Tax Department/Check post

Entry No. Reason Of Abnormal Stoppage Result If Any
Vehicle Date Time
Arrival
Depart

Date __________________ Signature ________________ Designation _______________