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Government of the People's Republic of Bangladesh
National Board of Revenue, Dhaka
VAT CHALLAN
As per [Rule 16 (1)]
Second copy
VAT 11
Ghallan No.
ii.ix
fr;.
ffi
[tu
Name of the Company
Address
VAT registration No
Buyer Name
Address
VAT Registration Nol
Final Destination of Goods/Sef
Type ofTransport & No
Date of Challan lssue3
Time of Challan lssue3
Date & Time of delivery3
Jhinaidha, Jessore
Sales Order No
I
1.
2
3.
4.
For sales of goods or services to registered buyer only, the name, address and VAT registration No. of the buyer should be filled in.
Applicable only when ultimate destination of goods rs different from buyers address.
Date & time of delivery should be mentioned both in words and figure.
ln case of direct or indirect export, export L/C or internal back to back L/C or for local/international tender, work order no, and date
(including bank name) etc informalion need to be mentioned along with the information of column No. 2
In this column, the quantity should be mentioned in figures and beneath it in words.
Signature of Seller & Date
st
No.
Name of Goods /
Servicesa
Quantity5
Value
chargeable to
supplementary
duty
Amount of
Supplementary
Duty
VAT
Chargeable
Value
t(4)+(s)I
Amount
of VAT
Total Value
including VAT &
Supplementary
Duty
I 2 3 4 5 6 7 8
MENT;SJPERCRE
CEMIIB,L42.5N;57
BAG
300.00
't500.00 3725.00 105225"00
Total: {REE HUNT TED BAGS )15CI0.00 3725.00 105225.00
rotarin words0NE FIUNnRED FIVE THOUSANil TWCI HUNDRED TId}ENTY FIVE *NLY
: LafargeHolcim Bangladesh Limited
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