FORM 20

[See rule 114 (1) and rule 127]

Application for creation of a loan liability under sub-section (10) of section 40 of the West Bengal Sales Tax Act, 1994

To

The ............................. (Specified Authority)

In accordance with the provisions of rule 114 or rule 127, as the case may be, of the West Bengal Sales Tax Rules, 1995, I ............................................. son of .................................... Proprietor/Partner/Karta/Principal Officer/Director/ Managing Director, on behalf of the registered dealer carrying on the business known as ............................... situated at ...................... and having certificate of registration No. .............. hereby apply for creation of a loan liability for the aforesaid dealer under sub-section (10) of section 40 of the West Bengal Sales Tax Act, 1994 for an amount of Rs. .......... (in figures) Rupees .................. (in words) in respect of the year ended on the ................../ part of year from the ................... to the .................... against the tax deferred for such year/part of a year under sub-section (1) of the said section. The details of the return period (s), prescribed date (s) of furnishing of return (s), amount of tax payable and the prescribed date (s) of payment of tax deferred under sub-section (1) of section 40, in respect of which a loan liability for the aforesaid dealer my be created, are given below :-

I shall enter into an agreement with the State Government in this regard and all the terms and conditions specified in the deed of agreement shall be binding on the aforesaid dealer, his successor, heirs and assigns.

The above statements are true to the best of my knowledge and belief.