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0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041…

Destination Copy C72302041/176 27-Jul-2023 JH02AW8735

Check Gate Copy
C72302041/176 27-Jul-2023 JH02AW8735
TRANSPORT TRANSPORT
436.000 28 Jul 2023CHALLAN 4:40:52 AM 436.000 28 Jul 2023CHALLAN
4:40:52 AM
FORM "D" C72302041/176 27-Jul-2023 FORM "D" JH02AW8735
C72302041/176 27-Jul-2023 JH02AW8735
[Rules 9] [Rules 9]
436.000 28 Jul 2023 4:40:52 AM 436.000 28 Jul 2023 4:40:52 AM
(See section 23-C of Mines & Minerals (Developement & Regulation) Act, 1957)
(See section 23-C of Mines & Minerals (Developement & Regulation) Act, 1957)
C72302041/176 27-Jul-2023 JH02AW8735
ORIGINAL (NOT TRANSFERABLE) C72302041/176
ORIGINAL 27-Jul-2023 JH02AW8735
(NOT TRANSFERABLE)

Serial Number : C72302041/176 Date : 27-Jul-2023

Serial Number : C72302041/176
436.000 28 Jul 2023 4:40:52 AM Date : 27-Jul-2023 436.000 28 Jul 2023 4:40:52 AM
Transportation for Inter State/Intra State Transportation for Inter State/Intra State
C72302041/176
(To 27-Jul-2023
be filled by the Lessee before JH02AW8735
transport of mineral)
C72302041/176 27-Jul-2023 JH02AW8735
(To be filled by the Lessee/Dealers before transport of mineral)
436.000 28 Jul 2023 4:40:52 TRUSTLINEAM
1.436.000 28 Jul of the2023
Lessee 4:40:52 AM
TRUSTLINE MINING AND MINING AND
Name and Address 1. Name and Address of the
MINERALS,TRUSTLINE MINING AND MINERALS,TRUSTLINE MINING AND
Lessee//Dealers Permits
Permits
C72302041/176 27-Jul-2023 JH02AW8735
MINERALS-KADAJAMDA C72302041/176 27-Jul-2023 JH02AW8735
MINERALS-KADAJAMDA

436.000 28 Jul 2023 4:40:52 TRUSTLINEAM

MINING AND 436.000 28 Jul 2023 4:40:52 TRUSTLINEAM MINING AND
2. Details of the Lessee Permit MINERALS,TRUSTLINE MINING AND 2. Details of the Lessee Permit MINERALS,TRUSTLINE MINING AND
C72302041/176 27-Jul-2023 JH02AW8735
MINERALS-0101597101-KADAJAMDA C72302041/176 27-Jul-2023 JH02AW8735
MINERALS-0101597101-KADAJAMDA

3. Name of Mineral/Grade
436.000 28 Jul 2023 4:40:52 STONE Stone Chips -Less than 120mm
AM 436.000 28 Jul 2023 4:40:52 AM
3. Name of Mineral/Grade STONE Stone Chips -Less than 120mm

4. Name and address of the purchaser to whom mineral has been sold and to be
4. Name and address of the purchaser to whom mineral has been sold and to be
C72302041/176 27-Jul-2023 JH02AW8735
supplied
C72302041/176 27-Jul-2023 JH02AW8735
supplied

436.000
BIJOY SHANKAR 28 MISHRA...-SINGHPOKHARIA,
Jul 2023 4:40:52 AM Sadar PS, WEST SINGHBHUM, 436.000 28 Jul 2023 4:40:52 AM
BIJOY SHANKAR MISHRA...-SINGHPOKHARIA, Sadar PS, WEST SINGHBHUM,
JHARKHAND,Pin Code- 833202- JHARKHAND,Pin Code- 833202-
C72302041/176 27-Jul-2023 JH02AW8735 C72302041/176 27-Jul-2023 JH02AW8735
5. Quantity (in
5. Quantity (in 436.000 Vehicle No JH02AW8735
436.000 Vehicle No JH02AW8735 Cft)
Cft)
436.000 28 Jul 2023 4:40:52 AM 436.000 28 Jul 2023 4:40:52 AM
6. Sale Price as mentioned in
6. Sale Price as mentioned in
C72302041/176
INVOICE (Submitted to Sales 27-Jul-2023 JH02AW8735
Total C72302041/176
INVOICE 27-Jul-2023 JH02AW8735
(Submitted to Sales
Total
52.00 Sale 22672.00 52.00 Sale 22672.00
Tax Department) per Tax Department) per
436.000 28 Jul 2023 4:40:52 AM
MT/CFT/M3
Price 436.000 28 Jul 2023 4:40:52 AM
MT/CFT/M3
Price

C72302041/176 27-Jul-2023 JH02AW8735

7.C72302041/176 7.08 27-Jul-2023 JH02AW8735
Royalty Royalty
Rate of Royalty 3086.88 7. Rate of Royalty 7.08 3086.88
Amount Amount
436.000 28 Jul 2023 4:40:52 AM 436.000 28 Jul 2023 4:40:52 AM
8. Name and address of Vehicle 8. Name and address of Vehicle
B S MISHRA-NA B S MISHRA-NA
C72302041/176 27-Jul-2023 JH02AW8735
owners C72302041/176 27-Jul-2023 JH02AW8735
owners

9.436.000 28 Jul
Name and address of the2023
Driver in4:40:52 AM
case the minerals is to be transported by Road 436.000 28 Jul 2023 4:40:52 AM
9. Name and address of the Driver in case the minerals is to be transported by Road

C72302041/176
ANIL 27-Jul-2023 JH02AW8735
NISHAD,NOAMUNDI-9652965320 C72302041/176
ANIL 27-Jul-2023 JH02AW8735
NISHAD,NOAMUNDI-9652965320

436.000 28 Jul SINGHPOKHARIA, Sadar PS,

2023 4:40:52 AM 436.000 28 JulSINGHPOKHARIA,
2023 4:40:52
WEST SINGHBHUM,
SadarAM
PS,
Direct to
WEST SINGHBHUM, Direct to 10. Place of delivery
10. Place of delivery
C72302041/176
of Mineral
JHARKHAND,Pin Code- 833202 Route Destination by
27-Jul-2023
WEST SINGHBHUM JH02AW8735 Road
C72302041/176
of Mineral 27-Jul-2023
WEST SINGHBHUM
JH02AW8735
JHARKHAND,Pin Code- 833202 Route Destination by
Road
JHARKHAND PIN-833202
436.000 28 Jul 2023 4:40:52 AM 436.000 28 JulJHARKHAND 2023 4:40:52 PIN-833202
AM
Distance in(K.M.) 75.000 Distance in(K.M.) 75.000
C72302041/176 27-Jul-2023 JH02AW8735 C72302041/176 27-Jul-2023 JH02AW8735
11. Date of dispatch of 11. Date of dispatch of
27 Jul 2023 Time 10:40:52 PM 27 Jul 2023 Time 10:40:52 PM
Mineral
436.000 28 Jul 2023 4:40:52 AM 436.000 28 Jul 2023 4:40:52 AM
Mineral

I/We here by declare that the above statements are correct and complete to the best I/We here by declare that the above statements are correct and complete to the best
ofC72302041/176
my/our Knowledge and belief. 27-Jul-2023 JH02AW8735 ofC72302041/176 27-Jul-2023 JH02AW8735
my/our Knowledge and belief.

436.000 28 Jul 2023 4:40:52 AM 436.000 28 Jul 2023 4:40:52 AM

Seal of Competent Officer Signature Of the Lessee/Permit holder Seal of Competent Officer Signature Of the Lessee/Permit holder
C72302041/176 27-Jul-2023 JH02AW8735 C72302041/176 27-Jul-2023 JH02AW8735
Challan Valid 27 Jul 2023 10:40:53 Challan Valid 27 Jul 2023 10:40:53
28 Jul 2023 4:40:52 AM
436.000 28 Jul 2023 4:40:52 AM
Upto
Printed on
PM 436.000 2828Jul
Upto
Jul 2023 4:40:52 AM
2023 4:40:52 AM Printed on
PM

C72302041/176 27-Jul-2023 JH02AW8735 C72302041/176 27-Jul-2023 JH02AW8735

436.000 28 Jul 2023 4:40:52 AM
RESULT OF CHECKING IN ROUTE 436.000 28 Jul 2023OF4:40:52
RESULT CHECKINGAM
IN ROUTE
Designation and Head Quaters Description Quantity of the Dated signature of the Designation and Head Quaters Description Quantity of the Dated signature of the
C72302041/176 27-Jul-2023
of the authority by of mineral Mineral
JH02AW8735 authority mentioned C72302041/176 27-Jul-2023 JH02AW8735
of the authority by of mineral Mineral authority mentioned
whom the transport of the actually in column-1 and place of whom the transport of the actually in column-1 and place of
mineral was checked.
436.000 28 Jul 2023 4:40:52 AM checking.
transported 436.000 28 Jul 2023 4:40:52 AM checking.
mineral was checked. transported

C72302041/176
Note- (1) Separate form27-Jul-2023 JH02AW8735
should be used for each consignment
C72302041/176 27-Jul-2023 JH02AW8735
Note- (1) Separate form should be used for each consignment
436.000 (2) 28
(a) InJul
case 2023
of 4:40:52
transport accross or AM
byond check post a copy of the form 436.000(2)28(a) InJul 2023
case of 4:40:52
transport AMcheck post a copy of the form
accross or byond
should accompany the consignment. should accompany the consignment.
C72302041/176 27-Jul-2023 JH02AW8735 C72302041/176 27-Jul-2023 JH02AW8735
0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041/176|27 Jul 2023 10:40:53 PM|436.000|0101597101|C72302041…

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