FORM VAT - 65

[See Rule 21 (11) ]

Indemnity bond

KNOW ALL MEN BY THESE PRESENTS THAT I_________________________________________ S/o ___________________________________________, registered dealer under the Rajasthan VAT Act, 2003 under registration No. (TIN)____________________________________dated _____________________ in the State of Rajasthan

I/We/M/s.___________________________________________________________a firm/ a company/…………………… registered under the laws of Rajasthan and having its registered office at __________________________ ___________________________________________________________________ registered dealers under the Rajasthan VAT Act, 2003 under registration No.(TIN)_________________________________________ in the State of Rajasthan (hereinafter called the Obligor ) is/are held and firmly bound unto the Governor of Rajasthan (hereinafter called the Government) in the sum of ______________(Rupees_________________ ___________________________________________________________________________) (In words) well and truly to be paid to the Government on demand and without demur for which payment to be well and truly made. I bind myself and my heirs, executors, administrators, legal representatives and assigns/ we bind ourselves our successors and assigns and the persons for the time being having control over our assets and affairs.

Signed this______________day of___________________Two thousand __________________

OR

WHEREAS subrule 8 of the rule 21 of the Rajasthan VAT Rules, 2006, requires that in the event a blank or a duly completed form of declaration is stolen, lost or destroyed while it is in custody or in transit between the purchasing dealer and the selling dealer or between selling dealer and assessing authority as the case may be, to furnish an indemnity bond to the authority from which the said form was obtained.

AND

WHEREAS the Obligor herein is such dealer.

AND WHEREAS the Obligor has lost the declaration in VAT __ , bearing No._________________________ which was blank/ duly completed, and was issued to him by ________________________________________________________ (name and designation of the authority)_____________________________________which was issued to him by _________________________________________________(name and designation of the authority ) and sent to _______________________________________________ ______________________(selling dealer )____________________________________/received by him from________________________________________________________________(name of the purchasing dealer)____________ _____________________________________________and sent to ___________ __________________________________ (notified authority of the selling dealer' State___________ ______________________________________) in respect of the goods mentioned below (hereinafter referred to as the Form).

Now the condition of the above written bond or obligation is such that the obligor shall in the event of a loss suffered by the Government (in respect of which the decision of the Government or the authority appointed for the purpose shall be final and binding on the Obligor) as a result of the misuse of the Form pay to the Government on demand and without demur the said sum of Rs. _________ ________ (Rupees)*_____________ _____________________________ __________ ________________\ (in words) and shall otherwise indemnity and keep the Government harmless and indemnified against and from all liabilities incurred by the Government as a result of the misuse of such Form. THEN the above written bond or obligation shall be void and of no effect but otherwise shall remain in full force, effect and virtue. The obligor further undertakes to mortgage/charge the properties specified in the Schedule hereunder written by execution of proper deed of mortgage/ charge for the payment of the said sum. [Whenever called upon to do so by the assessing authority].

SCHEDULE

(Give details of properties mortgaged/charged)

AND THESE PRESENTS ALSO WITNESSETH THAT the liability of the obligor hereunder shall not be impaired or / discharged by reason of any forbearance, act or omission of the Government or for any time being granted or indulgence shown by the Government, (or by reason of any change in the constitution of the obligor in cases where the obligor is not an individual.)

The Government agrees to bear the stamp duty if any chargeable on these presents. IN WITNESS WHEREOF the obligor " has set his hand/ has caused these presents executed by its authorised representatives, on the day, month and year above written.

Signed by the above named obligor.

In presence of :

1.

2..

(Obligor's signature)

Accepted for and on behalf of the Governor of Rajasthan by name and designation of the Officer duly authorised in pursuance of Article 299(1) of the Constitution, to accept the bond for and on behalf of the Governor of Rajasthan in presence of:

1.

2.

Name and Designation of the Office