The Orissa Entry Tax - Forms
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FORM E20

[See rule 9 (4) (a)]

APPLICATION FOR REFUND OF SECURITY

01.

Office address :

.................................................................

Date

Month

Year

02.

TIN/SRIN/Identification No.

03.

Name & address of the dealer:

-------------------------------------

04.	I have furnished security for Rs. _______________ (Rupees _____________)
	in the following manner :
	(Please "Tick" mark whichever is applicable)
(a)	by depositing in the Government Treasury vide challan No. __________dt. _______; or
(b)	by depositing in Post Office Savings Bank bearing account No. _________of ___________ Post Office and pledging the Pass Book in favour of __________ which was deposited with him on __________; or
(c)	by depositing in shape of National Savings certificate bearing No. _______of ______Post Office pledged in favour of _________________; or
(d)	by mortgaging immovable property bearing the following details in favour of____________ on ____________

Sl. No.	Description of Property	Location of the Property	Approximate value

05.

The security deposited is no longer required for the following reasons:

(a)

closure or discontinuation of business ; or

(b)

the period for which the deposit in the Post Office Savings Bank was made or the period of maturity of the National Savings Certificate has expired; or

(c)

the immovable property mortgaged is required to be retired for other purposes; or

(d)

any other ground to be specified;

ii)

iii)

06.

I have no arrears of tax, interest, penalty or any other due under the Act for payment;

I have arrears of Rs. ___________(Rupees ________________)towards tax, interest, penalty or any other due under the Act for the period __________________, which I have deposited through receipted Treasury Challan dt. ___________or crossed demand draft bearing No. _________ dt. ________ drawn ______________ branch of _______________ Bank;

I hereby authorise the registering authority to deduct the arrears of tax, interest, penalty or any other due under the Act, outstanding for realisation, to be deducted from the security furnished.

07.

I further undertake to replace the security refunded or I have already deposited equivalent amount of security in the prescribed manner as per details given below :

Amount	Manner of payment	Details of payment

there is no need for furnishing any security.

DECLARATION

I _____________________________ son/daughter/wife of ___________________ (Status)______________________ of the above mentioned business hereby declare that the information furnished in the form are true and correct to the best of my knowledge and belief. I undertake to intimate the registering authority immediately, of any change in the information furnished.

	Signature
Date of application ____/____/______	Status with stamp