THE GOA VALUE ADDED TAX RULES, 2005 FORMS
-

FORM VAT-V

[See rule 24(3)]

CHALAN

ORIGINAL

(To be retained by the payer)

0040-Taxes on Sales, trade, etc.

...................................................

Chalan of tax, licence and registration fees and other receipts paid

	Treasury/Sub - Treasury
into the ....................................................	State Bank of India
(Branch)	_________________

for the period from ................................ to ..................................

TIN

Name and address of the dealer on whose behalf money

Payment on account of	Amount (in figures ) Rs.
105- Value Added Tax
01-Tax Collection
02-Composition of Tax
03-Licence &
Registration Fees
04-Interest
800-Others receipts
81-Other items
Total

is paid.......................................

.........................................

By whom tendered.......................

....................................................

Rupees (in words) ............................................................................................................................

Dated:...........................	.............................................................
	(Signature of dealer or Depositor)

______________________________________________________________________________

(For use in the Tresuary/Bank)

1.	Received payment of Rs.....................................................................................................
	(in figures)
	Rupees...................................................................................................................................
	(in words)
2.	Date of entry.................................
3.	Chalan/Scroll No. ...................

(Signature of Accountant)

(Signature of Treasury/

Bank officer / Manager)

(Stamp of Treasury / Bank)

FORM VAT-V

[See Rule 24(3)]

DUPLICATE

(To be furnished by the payer to the respective Appropriate Assessing Authority)

0040 - Taxes on sales, trade, etc.

..........................................................

Chalan of tax, licence and registration fees and other receipts paid

	Treasury/sub - Treasury
into the .................................................	State bank of India
(Branch)	_______________

for the period from ............................to .........................

TIN

Name and address of the dealer on whose behalf money is paid ............................... .......................................... ................................................ By whom tendered...................	Payment of account of		Amount (in figures) Rs.
	105	-Value Added Tax
	01	-Tax Collection
	02	-Composition of Tax
	03	-Licence &
		Registration Fees
	04	-Interest
	800	-Others receipts
	81	-Other items
	Total

Rupees (in words).............................................................................................................................

Dated: ..................................	.....................................................
	(Signature of dealer or depositer)

______________________________________________________________________________

(For use in the Tresuary/Bank)

1.	Received payment of Rs.......................................................................................................
	(in figures)
	Rupees...............................................................................................................................
	(in words)
2.	Date of entry..............................
3.	Chalan/Scroll No....................

(Signature of Accountant)

(Signature of Treasury/

Bank officer / Manager)

(Stamp of Treasury / Bank)

FORM VAT-V

[See rule 24(3)]

CHALAN

TRIPLICATE

(for the Treasury)

0040-Taxes on Sales, Trade, etc.

...........................................................

Chalan of tax, licence and registration fees and other receipts paid

into the .......................................................................................

(Branch)

Treasury /Sub-Treasury State Bank of India

_________________

for the period from ....................................................to.....................................

TIN

Name and address of the dealer on whose behalf money is paid ............................... .......................................... ................................................ By whom tendered...................	Payment of account of		Amount (in figures) Rs.
	105	-Value Added Tax
	01	-Tax Collection
	02	-Composition of Tax
	03	-Licence &
		Registration Fees
	04	-Interest
	800	-Others receipts
	81	-Other items
	Total

Rupees (in words).............................................................................................................................

Dated:.....................

...............................................................

(Signature of dealer or depositor)

______________________________________________________________________________

(For use in the Treasury/Bank)

1. Received payment of Rs..............................................................................................................

(in figures)

Rupees................................................................................................................................................

(in words)

2. Date of entry...................................................

3. Chalan/Scroll No............................

(Signature of Accountant)

(Signature of Treasury/

Bank officer / Manager)

(Stamp of Treasury / Bank)

FORM VAT -V

[See rule 24(3)]

CHALAN

QUADRUPLICATE

(to be send by Treasury to respective Appropriate Assessing Authority)

0040-Taxes on Sales, trade, etc.

...........................................................

Chalan of tax, licence and registration fees and other receipts paid

into the .........................................................................................

(Branch)

Treasury/Sub-Treasury

State Bank of India

________________

for the period from ...............................to................................

TIN

Name and address of the dealer on whose behalf money is paid ............................... .......................................... ................................................ By whom tendered...................	Payment of account of		Amount (in figures) Rs.
	105	-Value Added Tax
	01	-Tax Collection
	02	-Composition of Tax
	03	-Licence &
		Registration Fees
	04	-Interest
	800	-Others receipts
	81	-Other items
	Total

Rupees (in words)..............................................................................................................................

Dated:....................

......................................................................

(Signature of dealer or depositor)

______________________________________________________________________________

(For use in the Treasury/Bank)

1. Received payment of Rs............................................................................................................

(in figures)

Rupees ..............................................................................................................................................

(in words)

2. Date of entry...................................

3. Chalan /Scroll No.............................

(Signature of Accountant)

(Signature of Treasury/

Bank officer / Manager)

(Stamp of Treasury / Bank)