Original Duplicate Triplicate Quadruplicate FORM JJ Delivery Note [See rule 15(3), 15(18), 15(19), 15(20), 15(21) ] (for sales / stock transfer / works contract / labour ) TIN Asst. Year ...... 1. (a) Name and address of the consignor (b) TIN (c) CST Registration No. 2. (a) Name and address of the consignee / branch / agent (b) TIN, if any. (c) CST Registration No. 3. Address (i) from which goods are consigned. (ii) to which goods are consigned 4. Description of goods consigned (a) Name of the goods. (b) Quantity or weight (c) Value of the goods 5. Purpose of transport (a) for sale / purchase (b) for shipment (c) transfer to branch / head office/Consignment agent (d) for execution of works contract (e) for labour work / processing 6. To whom delivered for transport and vehicle no., if any/ 7. Remarks, if any. I/We certify that to the best of my/our knowledge the particulars are true, correct and complete. Name and signature of the person to Name and signature of the consignor / whom the goods were delivered for his employee / his representative transporting with status of person signing. Place : Date : ** Note - (1) Original to be furnished to the officer incharge of the first check post or barrier, the second copy to such officer in the last check post or barrier and the third copy shall be retained by the owner or other person incharge of the goods vehicle or boat. (2) The entries in this form should be made in ink or by copying pencil using double side carbon paper. In the case of delivery notes issued in respect of goods intended to be transferred to a place outside the State of Tamil Nadu entries should be made in English. In other cases of transport such entries may be made either in English or in the official regional language of the State, namely, Tamil. (3) Any corrections made in the form should be duly attested by the person signing the form. **(4) The original, duplicate, triplicate and quadruplicate copies are to be printed in white, blue, red and yellow colours respectively for easy identification.
