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

THE WEST BENGAL VALUE ADDED TAX RULES, 2005

FORM 17

Application for Declaration

[See sub-rule (1) of rule 30C]

From :

............................................................................................................................ (Name of the Applicant)

....................................................................................................................... (Trade Name of the Dealer)

................................................................................................................................................... (Address)

Registration Certificate No. ......................................................................................................................

The Deputy Commissioner/Assistant Commissioner/Sales Tax Officer,

............................................................ Division / Charge

Kindly supply .............................................. (in figures) ......................................................................................... (in words) forms of declaration in Form 12A to ................................................................................ Who is hereby duly authorised to receive the said forms and acknowledge receipt thereof on my/our behalf. His signature, duly attested is appended below.

The original Registration Certificate, Register in Form 17B, used counterfoils, and unused declaration forms are produced herewith for your inspection and return. A statement indicating requirement of declaration forms is also enclosed for your consideration. Any other connected paper will be produced. If required. Relevant information regarding supply of declaration forms received in the past is furnished below.

..............................................
Attested signature of the authorised recipient
Date .......................................	Signature of the Applicant .....................................
	Status of the Applicant ..........................................

Particulars of the last two supplies received :-

	Date of issue	Serial No. of Forms
1.
2.
Stock-in-hand :

__________________________________________________________________________________________________________

N.B.- The application shall be signed by the person who has signed the application for registration or whose signature is provided in Form 7.

__________________________________________________________________________________________________________

ANNEXURE

Statement showing requirement of Declaration in Form 12A

(to be submitted with application in Form 17)

Trade Name of the applicant dealer :

Registration Certificate No. .........................................

Serial No.	Particulars of purchase
	Tax invoice No.	Date	Seller's Name & Address	R.C. No.	Description of Goods	Amount
(1)	(2)	(3)	(4)	(5)	(6)	(7)

Foreign Buyer's Order No. & Date	Description of goods as in the order/Contract	Shipping Bill No. & Date	Bill of Lading/Airway Bill of Consignment note			Description of the goods as per Shipping Bill/Airway Bill / Consignment note	Destination of goods
Foreign Buyer's Order No. & Date	Description of goods as in the order/Contract	Shipping Bill No. & Date	No.	Date	Name of Shipping Co./Airline/Transporter		Destination of goods
(8)	(9)	(10)	(11)	(12)	(13)	(14)	(15)

	Signature of the Applicant ...........................................
	Status of the Applicant ...................................................