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The Orissa Entry Tax - Forms
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Body

FORM E35

[See rule 30 (1) (b)]

REFUND ADJUSTMENT VOUCHER

Part - 'A'

Book No.
   

 

 
Date Month Year

     

 

Voucher No.
     

 

   

To    
  The Treasury / Special Treasury / Sub-Treasury Officer ,__________________________
01. Name of dealer or person, to whom issued. ____________________________________
02. TIN/SRIN/ Identification No. (In case of dealer registered under the Act)
 

 

03. Amount of refund due (in words) (Rupees ___________________________)
04. Date of order quantifying the refund
D D - M M - Y Y Y Y

                   

 

05. Details of amount deducted on account of any demand outstanding against the applicant.
Amount Demand with ref. to D.C.R Sl. and Date

 Admitted tax for the period.

Rs P
     
     

 

06. Net refundable amount in figure and in words (03-05) Rs _________________________________ (Rupees ____________________________)
07. Please debit the amount of Rs ________________ (Rupees _____________________ )

To Head of account --------------------------------- and credit the amount to the Head of account ---------------------------------------------.

08. A challan duly filled in is enclosed.  

Seal of the officer   Signature and Designation of the Issuing Office
     
Date ______________________    

Copy to M/s _______________________ at _____________________ for information.

    Signature and Designation of the Issuing Office

Part- 'B'

(To be returned to the Deputy / Assistant Commissioner of Sales Tax / Sales Tax Officer)

_____________________ Sub Treasury/Special Treasury/ Treasury

  The Treasury / Special Treasury / Sub-Treasury Officer ,__________________________
 
 

 

D D - M M - Y Y Y Y

                   

 

To

The Deputy / Assistant Commissioner of Sales Tax / Sales Tax Officer,

_____________________ Range / Circle

Ref : Refund Adjustment Vr. No ____________ / Book No__________________ Dated the ___________________

Sir,

Adjustment of refund of Rs _________________ (Rupees _______________)

payable to M/s _____________________________ is allowed on _______________.

Seal of the officer Sub-Treasury / Special Treasury / Treasury Officer
Date _______________ ______________________