The Orissa Entry Tax - Forms
-

FORM E36

[See rule 30(1)(b)]

REFUND PAYMENT ORDER

Part I

(To be retained in the office of issue)

Book No.

Date

Month

Year

Voucher No.

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 figure and in words)

Rs.________________________________ (Rupees ____________________________)

04.

References to P.C.R. serial No. and date vis-à-vis Treasury Schedule No. showing the collection of the amount, now being refunded.

Amount	Period	Reference to P.C.R. Sl. No and date	Treasury Schedule No.

05.

Date of order quantifying the refund

________________________

Signature of the receiptant of the Voucher	Signature and stamp of the Issuing Officer
Date ______________________	Date _______________________
Date of encashment in the Govt. Treasury __________________________________

Part II

ORDER FOR REFUND OF TAX / INTEREST / PENALTY / SECURITY

[Head of account -----------------------------------------------payable at the Govt. Treasury within three months of the date of issue.]

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

Please pay to ________________________

01.	Name of the dealer or person, ___________________________________ to whom payable
02.	TIN/SRIN/Identification No. (In case of dealer registered under the Act) _______________________________________
03.	The sum of Rs	_______________________________ (Rupees ____________________________)
	towards refund of tax / interest / penalty / security paid for the period (s) from ______ to _______________ vide order dated referred to P.C.R. serial No. ______ dt ______ & Treasury Schedule No._______ Date________

Seal of the officer		Signature and designation of the Issuing Officer

Date _______________

(To be filled in by the Treasury)

Date of encashment in the Govt. Treasury at _________________________

Pay Rs. ________________ (Rupees __________________________)

	Treasury officer,
Date ______________________
	Received payment.
	Signature of the claimant.

Part III

(Treasury officer's copy not to be encashed)

Book No.

Date

Month

Year

Voucher No.

[Head of account "------------------------------------------------"]

ORDER FOR THE REFUND OF TAX / INTEREST / PENALTY / SECURITY PAYABLE AT THE GOVT. TREASURY WITHIN THREE MONTHS OF THE DATE OF ISSUE.

The Treasury officer , ________________________

Please pay to -

01.	Name of the dealer or person, ___________________________________ to whom payable
02.	TIN/SRIN/Identification No. (In case of dealer registered under the Act) _______________________________________
03.	The sum of Rs	_______________________________ (Rupees ____________________________)
	towards refund of tax / interest / penalty / security paid for the period (s) from ______ to ______________ vide order dated referred to P.C.R. serial no. __________ dt __________& Treasury Schedule No. ____________ Date._________

Seal of the officer		Signature and designation of the Issuing Officer

Date _______________

To be filled in by the Treasury

Date of encashment

Govt. Treasury at ___________________________________

Pay Rs ________________ (Rupees ______________________) only.

	Signature of the Treasury officer
Date ______________
	Received payment.

	Signature of the claimant.