THE WEST BENGAL VALUE ADDED TAX RULES, 2005 : FORMS
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THE WEST BENGAL VALUE ADDED TAX RULES, 2005

FORM 73

[ See sub-rule(1) of rule 174 ]

Application for creation of a loan liability under sub-rule (7) of rule 165 of the West Bengal Value Added Tax Rules, 2005.

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

In accordance with the provisions of rule 174, as the case may be of the West Bengal Value Added Tax Rules, 2005, 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-rule (7) of rule 165 of the West Bengal Value Added Tax Rules, 2005 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 output tax deferred for such year/part of a year under sub-rule (1) of the said rule. The details of the return period(s), prescribed dates) of furnishing of return(s), amount of tax payable and the prescribed date(s) of payment of tax deferred under sub-rule (7) of rule 165 in respect of which a loan liability for the aforesaid dealer may be created, are given below

Period of return

Prescribed date for furnishing of return

Amount of output tax payable and deferred

Prescribed date of payment of deferred tax.

I shall enter into an agreement with the State Government in this regard and all the terms and conditions specified ion 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.

Date :

Signature :

Designation :

*Strike out whichever is not applicable

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