The Chhattisgarh Value Added Tax Rules, 2006. - FORMS
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FORM 65

[See rule 74 (2)(c)]

Application for obtaining declaration in form 59

To,

The Commercial Tax Officer,

_______________________

Sir,

* I/We, ______________ am/are carrying on Business under the name and style of ___________situated at _____________(city/town/village) ___________ (Tehsil) _______________ (District) and holding registration certificate No._________ under the Chhattisgarh Value Added Tax Act. 2005

1. I/We request that___________ books of declaration form 59 containing 50 Forms/*____________ loose forms be supplied to * me/us, the fee for which* I/We have paid into the treasury and in support of which * I/We enclose a treasury receipted challan in form 34 bearing No. _________ Date _______ for Rs.___________

2. * I/We declare that * my/our Registration certificate mentioned above is in force and has not been cancelled till this date.

3. *I/We further declare that *I/We am/are not in arrears of any dues for any period under any Act.

*I/We are in arrears of dues under the Act, the particulars of which are given below.

	Name of the Act	Period	Amount (in rupees)
1.
2.
3.
4.
			*Signature of the Proprietor/Manager/Secretary of the Company/partner of the firm.

Received _____________ Books bearing No. from________ to _____/* _______ loose forms bearing No. from ________ to ___________

	Signature of the dealer or his authorized representative

* Strike out whichever is not applicable.