THE GOA VALUE ADDED TAX RULES, 2005 FORMS
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FORM VAT-IV

[See rule 6(7) of the Goa Value Added Tax Rules, 2005]

Return of Sales and Composition Tax Payable by dealer opting for composition for the quarter ended

D	D		M	M		Y	Y	Y	Y

Period from

TIN:-

Valid upto

2.	Name of the Dealer	:_______________________________
3.	Address of the Dealer	:_______________________________
4.	Style of Business	:_______________________________
5.	Nature of Business	:_______________________________
6.	Total turnover of Sales received and receivable during the period.	:Rs._____________________________
7.	Amount of Composition Tax payable.	:Rs._____________________________
8.	Amount of Composition Tax paid	:Rs._____________________________
9.	Number and date of receipted copy of chalan under which payment is made, attached to this return in proof of payment.	:_______________________________
10.	Details of Bank Account (only the changes in the Bank Account, if any, during the return period to be reported.)

DECLARATION

I Shri/Smt____________________ of M/s __________________________________________ do solemnly declare that the particulars disclosed in this return are true to the best of my knowledge and belief and that I/we have not been covered under any of the contingencies stated in sub-rule(2) of Rules 6 during the period covered under this return.

Place:	_______________________
Date:	(Signature of the dealer)