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

FORM-43

[See Rule 30(2)]

APPLICATION FOR REFUND BY EXPORTERS

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 together with number of the certificate of registration, (TIN) if any.
3.	Tax period for which refund is claimed
4.	Value of goods exported out of the territory of India
5.	Amount of input tax due for refund as result of export out of the territory of India
6.	Amount of refund claimed
7.	Evidence in support of export on account of which, refund is claimed (copies of documents to be enclosed)
8.	The basis on which the amount of refund of input tax has been claimed (Documentary evidence, if any, to be enclose)

	Signature of the person making the application
Date:	Name
	Status

VERIFICATION

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