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

FORM-63

[See Rule 41(9)]

TAX CLEARANCE CERTIFICATE

1	Name and business of the applicant . . . . . . . . . . . . . . .
2	Father's name of the applicant . . . . . . . . . . . . . . . . . . . .
3	Home address of the applicant . . . . . . . . . . . . . . . . . . .
4	Year in which the business was established.
5	Name and address of the office in which the applicant is assessed to sales tax.
6	Whether the applicant is assessed to tax as ...
	(a) Individual . . . . . . . . . . . . . . . . ...... . . . . . . . . . . . . . .
	(b) Hindu Undivided family . . . . . . . . . . . . . . . . . . . . . ..
	(c) Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
	(d) Firm or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
	(e) Association of persons . . . . . . . . . . . . . . . . . . . . . . . . .
7	The Sales Tax Unit/District in which the applicant is assessed to sales tax.
8	(a) Registration Certificate No. . . . . . . . . . . . . . . . . . . . . . . .
	(b) Particulars of tax paid.

Tax period ending	Tax assessed	Tax paid	Remarks
1	2	3	4

Note : Amounts of tax in columns 2 and 3 above should include penalties etc. imposed under the Assam Value Added Tax Act, 2003.

(c)	If any sales tax demanded remains unpaid, reasons for it should be clearly stated

(d)	Whether the company of firm or Hindu undivided family on which the assessment was made has been or is being liquidated, wound up, dissolved, partitioned or being declared insolvent as the case may be.

9	In case the applicant is not a registered dealer under the Assam Value Added Tax Act whether any notice have been received and complied with the amount of tax, if any, determined and paid for each of the above return period.

10	The name and address of Branches of the applicant ...

11	Purpose for which the clearance certificate is required-

I declare that the above information is correct and complete to the best of my information and belief.

Signature of the applicant or his authorised agent.

In my opinion, the applicant mentioned above has been doing everything possible to pay the tax demands promptly and regularly the completion of pending or outstanding proceedings.

VALID UP TO...........................

Date ..........................

Place..........................	Signature of the Prescribed Authority
Unit/District..............................