The Assam Value Added Tax Rules, 2005. Forms
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THE ASSAM VALUE ADDED TAX RULES, 2005

FORM-18

[See Rule 18(4)]

APPLICATION FOR REFUND OF THE FORFEITED AMOUNT

To,

The Prescribed Authority.

____________________

Subject:

Claim for refund of tax collected un-authorisedly.

Reference :

Notice No____________dated _________publishing the forfeiture of tax amounting to Rs.................(Rupees.............................) only.

Sir,

With reference to the above, I have the honour to furnish the claim of refund of the amount of tax collected un-authorisedly from me. The details of the same are given below:-

1.	Name and full address of the person claiming refund	:
2.	Name and full address of the registered dealer who collected the tax and from whom the goods were purchased	:
3.	Description of the goods purchased	:
4.	Quantity and weight of the goods purchased	:
5.	Value of the goods (excluding tax)	:
6.	Amount of tax collected	:
7.	Cash memo No/Bill No. supported by money receipt No. and date containing particulars at Sl. 3 to 6 above evidencing charging of the tax amount	:
8.	The amount of refund claimed & grounds thereof	:

Date :

Place : Yours faithfully,

Full name of claimant _____________

Signature________________________

VERIFICATION

I Shri/Smti. .....................................son/daughter/wife of Shri.........................................(Address)..................................................do hereby state that the particulars furnished above are true to the best of my knowledge and belief. I further declare that I have not passed on the tax claimed by me to another person in any form and or in any manner.

Date:
Place:	Full name of the claimant
	Signature

1. Signature, name and address of at least one witness known to the Prescribed Authority certifying the bonafides of the claimant