THE KERALA GENERAL SALES TAX RULES, 1963

FORM No. 26

FORM OF DELIVERY NOTE

See Rules 32 (17) and 35 (13)

(To be maintained in triplicate marked original, duplicate, triplicate and serially machine numbered)

Name and dated Signature of the consignor/his agent/his manager
Serial Number :
Office of issue :
Seal of issuing authority :
Name of the dealer to whom issued with his registration certificate number :
I.  (a) Name and address of the person consigning the goods :
(b) Consignor's Registration Certificate Number under the KERALA General Sales Tax Act. 1963. :
(c) Date of issue of the delivery note by the consignor :
  (I) In figures :
  (2) In words :
(d) Time of commencement of the journey :
II. Full address of the place:
  (1) From which they are consigned :
  (2) To which they are consigned :
III. Name and Full address of the consignee with registration number if any. :
IV. Description of the goods:
(I) Name of goods consigned :
(2) Quantity or weight :
  (i) In figures :
  (ii) In words :
  (iii) Value of the goods :
      (i) In figures : Rs.
       (ii) In words : Rs.
V (1) Name and address of the owner of the vehicle or vessel by which the goods are consigned.
(2) Registered number of the vehicle or vessel.
VI. (a) If the consignor is transporting goods in pursuance of a sale for the purpose of delivery to the buyer, Bill No. and date relating to the sale, the name and address of the buyer and his Registration Certificate Number under the respective State Acts if he is a dealer
(b) If the consignor is transporting the goods after purchasing them, the name and address of the person(s) from whom the goods were purchased, his Registration Certificate Number and the bill number and date relating to the purchase, or and if the seller has not issued bills or cash memorandum, the number and date of the purchase bill or bought Note issued by the purchasing dealer.
(c) If the consignor is transporting the goods from his shops or godowns to another for the purpose of storage or sale, the address of the agent or the shop or godown to which the transport is made.
(d) If the consignor is transporting the goods to his principal, the name and address of the principal, his Registration Number in the respective State.
(e) If the consignor is transporting the goods to his agent for sale on consignment basis, the name and full address of the agent to whom the goods are sent and his Registration Certificate Number in the respective State.
(f) If the goods were purchased from persons other than registered dealers such as agriculturist, a declaration from such persons that the goods are his produce and that he is not liable to pay tax by virtue of his being an agriculturist should be enclosed.
  I/We certify that to1he best of my/our knowledge the particulars furnished are true  and correct.
Name and address and signature of the persons  to whom the goods were delivered for transporting with Status of the person signing.  
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 Kannada, as the case may be.
3. Any corrections or alterations made in the form should be duly attested by the person signing the form.