FORM XXXIII
(See Rule 46 (3) (b))
IN TRIPLICATE

Collection of tax at ..................................................................................................................... check post on goods
            Statement of goods transported without documents or with defective documents.
                  1.    Serial Number in the Register of check of lorries.
                  2.    Date of hour of check
                  3.    Vehicle Number.
                  4.    Name of Driver with address
                  5.    (a)    Name and address of the owner of the goods
                         (b)    Is he the consignor or the consignee
                  6.    Nature of Goods
                  7.    (a)    Name of goods
                         (b)    Volume or quantity
                         (c)    Value
                  8.    Brief Statement of the offence or irregularity committed
                  9.    (a)    Name of the payer
                         (b)    On whose behalf paid
                10.    Tax realised
                         (a)    Amount.
                         (b)    Serial number of receipt issued.
                         (c)    Challan number / date
                         (d)    Name of treasury / bank in which the amount was remitted.

                                                                                                                                Signature of the Checkpost Officer,
                                                                                                                                                Designation.

Note:-    The form should be in triplicate.  The triplicate should be retained in the check post.  The duplicate should be sent ot the Commercial Tax Officer having juridiction over the checkpost or barrier as the case may be for taking the particulars into account for preparing the relevant returns.  The original should be sent to the assessing authority.

Note:-    Inserted by G.O.Ms.No.249 Rev. dt.3.3.1976.