Andhra Pradesh Value Added Tax Rules, 2005- Forms
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Body

FORM VAT 501 F

(See Rule 17C(i))

Declaration and Undertaking

Declaration to be issued by the dealer for tax on sales of High Speed Diesel (HSD)/Furnace Oil to the Foreign going International Ships under section 4A(a) of the Andhra Pradesh Value Added Tax Act, 2005.

This is to certify that I/We .......................................... (Name and full address of the dealer with TIN) have sold the following goods as per the details mentioned below:

Sl. No.	Name and address of the purchaser	Invoice No./ Date	Marine Delivery Receipt No. & Date	Name of of Inter-national Ship	Name of the shipping agent	Description of the goods sold	Sale value	VAT amount payable
1	2	3	4	5	6	7	8	9

I hereby declare that the sales of the above mentioned goods are eligible for tax @ 0.5% under Section 4A(a) of the Andhra Pradesh Value Added Tax Act, 2005. In the event of finding that the above information is false, I/We hereby undertake to pay to the Government the differential tax amount without prejudice to the penal action taken against us.

Place:	Signature:
Date:	Name & Address:
	Seal.