Form VAT 17

[See Rule 24]

Notice for Payment of Demand

Registration No. (TIN).........................................

1. Name of Dealer/ Person

2. Address

Bldg No/Name/ Area

Town/City

District (State)

Pin Code

Email Id

Take notice that you have been assessed to tax / a penalty has been imposed on you/an interest has been charged on you /an exemption or composition fee is payable by you, amounting to Rs ................ (in words)........................................... in connection with the tax assessment or other order for the period ............................. Rs ........................... (in words also) ................................................................................. already deposited by you .................................. have been adjusted.

Rs ............................ (in words also) ................................................................. ................................ claimed by you as deposited and supported by receipts but not verified, shall be adjusted after verification to be made by this office.

The outstanding Amount of Rs. ................ be paid by you in the Treasury or the Bank authorized to receive money on behalf of the State Government by the ...............................day of .......................... year ............................. / within thirty days from the service of this notice,.

Please note that if the amount is not paid within the said time, it shall be recoverable as arrears of land revenue and you shall be exposed to all modes of recovery provided in the Act and further you shall also be liable for to prosecution under the Act.