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

FORM 17A

Statement of issue of declaration forms received on the previous occasions

[See sub-rule (3) of rule 30G]

Registration Certificate No. of the issuing dealer .............................................

Name and address of issuing dealer :	Covering purchase of ...................................................... (year)
......................................................	By Form No. 12A
......................................................

Serial No. Of declaration forms 12A issued

Date of issue

Dealer to whom form was issued

Purchase order No. & date

Seller's Tax Invoice No. & date in reference to which Forms 12A have been issued

Value

(Rs.)

Serial Nos. Of Forms lying in stock on the date of application

Name

Registration Certificate No.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

Certified to be true and correct,
Date ..........................................	Signature of the Applicant ...................................
	Status of the Applicant .......................................