THE KERALA VALUE ADDED TAX RULES, 2005 - Forms
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THE KERALA VALUE ADDED TAX RULES, 2005

FORM NO. 21H

APPLICATION TO PAY ARREARS OF TAX IN INSTALMENTS

(See Rule 51)

Tax payers Identification No

The Assessing Authority

(with Office Address)

Presumptive tax payers Identification No.

Central Sales Tax No.

I........................... being an assessee under the Kerala Value Added Tax VAT Act,2003, hereby apply for permission to pay the tax assessed/due from me in instalments as per the following details:

1	Name and address of the assessee
2	Amount of tax for which instaments are sought
3	If the sums in column(2) are payable under an order of assessment, the date of such order
4	The period within which permission to pay the sum in column (2) is sought
5	Reasons for the applicant' inability to pay the tax/other amount due within the specified date
6	Other information (if any)

DECLARATIONS

(1) I hereby declare that to the best of my knowledge and belief the information contained in the above application is true and correct.

(2) I hereby declare that no application for instalments has been made to any other authority in regard to the sums mentioned in column (2)

(3) I hereby declare that no sums other than those mentioned in column (2) are due from me on the date of making this application.

(4) I hereby undertake to pay interest at the rate of - (insert rate) per annum along with each instalment on the sums remaining unpaid from time to time.

(5) I hereby undertake to furnish necessary security to the satisfaction of the concerned assessing authority for the recovery of the sums in relations to which the grant of instalments is applied for.

Place :

Date:

SEAL

Name, Signature & Status of the Applicant