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FORM XXI
Department of Commercial Taxes , Goverment of Uttar Pradesh
[See Rule - 40(1) of the UPVAT Rules, 2008]
Transport Memo
     
Enter Serial No. :    
 
Tin No :
 
With Effect From :
Selling Dealer in UP
     
Name of Consignor : Address of Consignor :
Tin No. : With Effect From :
Mobile No. :      
Purchasing Dealer in UP
Tin No. :
 
With Effect From :
 
Name of Consignee :
 
Address of Consignee :
 
Mobile No. :      
Details of goods received by transporter  from the consignor
 
Appropriate Value of goods ( price range ) :
 
Name of Transporter , Carrier or Forwarding agent :    
Address of Transporter , Carrier or Forwarding
agent
:  
Service Provider No. :       With Effect From :
Pick a date
Phone No. :       Goods Receipt(GR) No.*     
Goods Receipt(GR) Date * : Pick a date   Goods Receipt Place * :     
Private Marka written by Transport co. on packages / packets :    
Vehicle No * :     Place from goods were loaded* :     
Date and Time of start of journey * : Pick a date