The Kerala General Sales Tax - Forms
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FORM 21CC

See Rule 18A

The Assessing Authority....................

I, ............ Being a registered dealer having registration certificate number...........dated ........under the Kerala General Sales Tax Act, 1963 and carrying on business known as.........whereof the only/principal place of business within your jurisdiction is situated as shop No.....name of building.........ward/locality ...........Road.................Village..........Post Office .........do hereby declare that admitted in the return in Form No. 8 submitted along with this statement [has been paid.] I have also fully paid the tax due or tax collected by me along with return if Form No. 8.

I further declare that I have not taken out registration under the Kerala General Sales Tax Act, 1963 with any other Assessing Authority and I have no business in any place other than what is declared above.

The above statement is true to the best of my knowledge and belief.

Place :	Signature and name of the sealer.
Date :	Status in relation to the Business.

Notice of Assessment (To be issued by the Assessing Authority)

I have verified the above statement and found that the dealer is entitled for the year ended 31 st March 19.........as under:

Total turnover	Rs.
Exempted turnover	Rs.
Taxable turnover	Rs.
Tax due	Rs.
Tax collected	Rs.
Additional Sales Tax due	Rs.
Surcharge due	Rs.
Total payable	Rs.
This has been paid
Place : ........................	Signature of the Assessing Authority
Date : ........................	(Seal)

Note :- This form should be filed in triplicate and the Assessing Authority shall return the duplicate copy along with the notice of assessment to the dealer.