THE KERALA VALUE ADDED TAX RULES, 2005

FORM No. 15
FORM OF DELIVERY NOTE
[See Rule 22(3) and 58(16))
(To be maintained in triplicate marked original, duplicate, triplicate and serially
machine numbered)

1. Book No./Serial No.

2. Office of Issue

VAT OFFICE
ADDRESS

SEAL

3. Date of issue by consignor

d d

m m

y y y

4.Time of commencement of journey

TIN

5. Name and address of the consignor

TIN

6.Name and address of the consignee

7

Place from which goods are consigned

i d

8. If the consignor is transporting goods:

(a) In pursuance of sale for purpose of
delivery to the buyer:
(b) After purchasing them from registered
dealers;
(c) After purchasing them from unregistered
dealers or agriculturists
(d) From one of the shops or godown to
an agent for sale

Place to which goods are

(e) From shop to godown to another shop

or godown for purpose of storage or sale or;
(f) To his principal having purchased
them on his behalf; or
(g) To his agent for sale on consignment
basis
(h) Other purposes (Specify)

(Mark whichever is applicable)

9.

The Name and address and TIN, if any, of the Dealer/Person

from whom goods were purchased/procured

10.Description, quantity and value of goods.

Sl.No.

Commodity

Invoice No./Date

Quantity

Value of Goods

11. Name and address of the owner of the goods vehicle or vessel by which the goods are
consigned

Name
Address

Vehicle/Vessel Number

I/We certify that to the best of my / our knowledge the particulars furnished herein are true,
correct, complete and that nothing has been concealed therein.
Name, address , signature and Driving license
of the driver of the vehicle

Free text box for instructions:

Name and dated signature of the

Consignor or his authorised

Seal of dealer

Note:- 1.
Original to be furnished to the Assessing Authority
concerned. Duplicate to be retained by the purchasing dealer or the person to
whom goods were delivered for transporting. triplicate to be retained by the
consigning dealer.
2. The entries in the duplicate and triplicate shall be carbon copies of the entries
in the original. In the case of delivery notes issued in respect of goods intended
to be transferred to a place outside the State of Kerala, entries should be made
in English. In any other case of transport such entries may be made either in
English or in the language of the State namely, Malayalam, Tamil or Kannda,
as the case may be.
3. Where the particulars of goods transported cannot be fully included under
column 10 the dealer shall use separate sheet which shall be the delivery
chalan referred to in Rule 58 (18)(A).
4. Any corrections or alterations made in the form should be duly attested by the
person signing the form.