THE KERALA VALUE ADDED TAX RULES, 2005

FORM No. 21A

REFUND ORDER

(UNDER SECTION 89 (3))

[See Rule 48]

No:

To

Name and Address of the Dealer

1. Certified with reference to the records of M/s......................bearing TIN...........for the period from ...........to...........that a refund/ reimbursement of Rs................(Rupees......................) (in words) only is due to M/s ...........................

2. Certifed that refund of the said amount concerned by this order had not been granted previously

3. This refund will be adjusted towards the amount of Rs……… due from the said refundee under the provision of Kerala Value Added Tax Act, 2003 / Kerala General Sales Tax Act, 1963/ Central Sales Tax Act, 1956 / Entry Tax Act, 1994 for the period from ........................to ..........................

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