Form VAT-XV-C

[See rule 42 /43]

RETURN OF TAX REALISED IN CONTRAVENTION OF THE PROVISIONS OF SECTION 20

1. Dealer's identity

I______________ solemnly affirm and declare that the statements made and particulars furnished in and with this return are true and complete to the best of my knowledge and belief and nothing has been concealed therefom.

Place:.......

Daee........

Full signatures of the dealer or authorised agent.

Status : (Tick) applicable [Karta, proprietor, partner, director, president, secretary, manager, authorised officer]

________________________________________________________________________________

(For use in the office of the Assessing Authority)

(1) Date of data entry in VAT- register/Computer:

(2) Signature of the official making the data entry:

(Affix stamp of name and designation)

(3) Signature of the Assessing Authority with date:

ACKNOWLEDGEMENT

Received from M/s____________________________ TIN _____________________a return in Form VAT-XV-C of tax payable under section 20 for the month of______________alongwith a list in Forms LS-2.

Assessing Authority/

Excise and Taxation Inspector,

(when posted in circle outside District Headquarters)

Circle_________District_______.

(SEAL)

Date_____________