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

FORM-41

[See Rule 29(2)(c)]

APPLICATION FOR REFUND OF INPUT TAX CREDIT

To,

The Prescribed Authority,

Unit_____________.

Subject :

Application for refund.

Sir,

I hereby apply for release/refund of security furnished by me, the particulars are given below:-

1.	Name and address of the person claiming refund
2.	Name and style of business
3.	Tax Payer Identification Number (TIN).
4.	Tax period for which refund is claimed
5.	The amount of input tax credit carried forward and claimed as refund
6.	The reasons for which the input tax credit now being claimed as refund, could not be adjusted during the 24 months from the year of accrual
7.	Evidence, if any, in support of such reasons (To be enclosed)

VERIFICATION

I hereby solemnly declare that the above statements are true to the best of my knowledge and belief.