THE GOA VALUE ADDED TAX RULES, 2005 FORMS
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Form VAT- XXVI

[See rule 9(1)]

APPLICATION FOR REFUND OF TAX UNDER SECTION 34(1) OF THE GOA

VALUE ADDED TAX ACT, 2005. (Act 9 of 2005)

1.	Name and address of the applicant dealer (exporter).....................................................

TIN

Quarter/period during which sales are made and in respect of

which the refund is claimed......................................

Amount of refund claimed......................................

Details of sales (a separate Annexure to be attached in the following proforma):

Sr. No.	Sale Invoice		Description of goods	Quantity	Sale price of goods	Name and address of the purchaser	Mode of dispatch with supporting documents	Mode of Payment.
Sr. No.	No.	Date	Description of goods	Quantity	Sale price of goods	Name and address of the purchaser	Mode of dispatch with supporting documents	Mode of Payment.
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)

6.	Details of purchases of goods made within the State against the Tax Invoices related to aforesaid sale of goods (a separate Annexure to be attached in the following proforma).

Sr. No.	Dealer from whom goods purchased (Name & address)	TIN	Tax Invoice		Description of goods
Sr. No.	Dealer from whom goods purchased (Name & address)	TIN	No.	Date	Description of goods
(1)	(2)	(3)	(4)	(5)	(6)

Quantity	Price of goods	Tax Charged	Purposed of purchase i.e. for use in manufacture or for resale.
(7)	(8)	(9)	(10)

7.	The return for aforesaid period in Form VAT-VIII and in Form I under the Central Sales Tax (Registration and Turnover) Rules, 1957 are filed separately.

DECLARATION

I., hereby, declare that the above particulars are true to the best of my knowledge and belief. Further, I declare that no application for refund in respect of the present claim has made earlier.

Place:

Date:

Signature of the dealer or his

authorised representative.

Status..........................................