Form D-IV
Form of declaration to be issued by transferor under the Bihar Value added Tax Act, 2005
Sl No. ...........
Form of declaration to be issued by transferor under the Bihar Value Added Tax Act, 2005
See Rule 12 (5)
Counterfoil
Name of issuing dealer ------------------------------- along with his TIN -------------------------------------
To
---------------------------------------------- (transferee)
Taxpayer identification No.. ----------------------
1. Certified that goods transferred by me/us as per details below are inputs purchased by me from inside the state of Bihar.
Quantity and/ or weight
Value of goods -----------
No. & date of challan under which goods sent -------------------------------
Mode of transport with vehicle No-------------------.
No. & date of R.R. or lorry challan or any other documents indicating means of transport-------------
2. Certified also that I have paid tax amounting to Rs --------------------------------------
(Rupees--------------------------------------) at the time of purchase of aforementioned goods from M/s----------------------------------------------bearing Taxpayer Identification No.---------------
The above statement are true to the best of my knowledge & belief
Signature.
Dated----------------------
status----------------------
(Name of the person signing the declaration with status)
Note: To be retained by the transferor.
Signature
Status ---------------------------
Original
Name of issuing dealer -------------------------------
Along with his TIN --------------------------------------
-------------- (transferee)
Taxpayer identification No.. -----------
No. & date of challan under which goods sent --------------------------------
Mode of transport with vehicle No-----------------.
No. & date of R.R. or lorry challan or any other documents indicating means of transport------------------------
2. Certified also that I have paid tax amounting to Rs--------------
(Rupees--------------------------------------) at the time of purchase of aforementioned goods from M/s-----------------------------------------------bearing Taxpayer Identification No.------------------
Dated-------------------
status------------------
Note: To be given to the transferee.
Status ----------------
Duplicate
Taxpayer identification No.. ---------
Mode of transport with vehicle No---------------.
Dated--------------------
status--------------------
Status --------------------