The Orissa Value Added Tax Rules, 2005 FORMS
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FORM C-4

INTIMATION OF THE NAME AND ADDRESS OF THE DEDUCTING AUTHORITIES

1. I am executing the following works contracts during the year ................, covered under permission for payment of tax by way of composition in lieu of VAT.

2. I am furnishing below the name and address of the deducting authorities, from whom I am receiving payments against execution of the works .

SI.No.	Name of the work and its location	Value of the work	Name and address of the deducting authority	Remarks
(1)	(2)	(3)	(4)	(5)
1
2
4
4
5

(Use separate sheet if the space provided is inadequate)

3. I further undertake to intimate any change in the information furnished above, immediately on occurrence of the change.

Place

Date