THE HIMACHAL PRADESH VALUE ADDED TAX RULES, 2005. FORMS
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Form VAT-XV-E

[See rule 47 (5)]

Form of return to be furnished by a Lottery Dealer

Original/Duplicate copy of return for the quarter ended on:

1. Dealer's identity

Name and style of business

M/s

Address

Contact No.

TIN

Economic Activity Code

2. Details of draws during the tax period and tax payable thereon-

Serial No.	Type of Dealer	No. of draws during the tax period	Lump sum tax payable in respect of each draw during the tax period
(1)	Daily lottery
(2)	Weekly lottery
(3)	Monthly lottery
(4)	Festival lottery
(5)	Instant lottery

		Total Tax payable =
		Paid =

Note: Date-wise details of each type of draw are attached separately as per Annexure(s)

3. Account of forms printed under the Government authority or required to be authenticated by Assessing Authority

Serial No.	Type of Form	Opening stock at the beginning of the return period	Blank forms received or authenticated during the return period	Number of Form used during the return period	Number of forms in stock at the end of return period
(1)	VAT-
(2)	C

4. Aggregate price of goods purchased in the course of inter state trade against 'C' Forms

List LP-1 appended

Declaration

I, _____________(name in CAPITALS), hereby, solemnly affirm that I am authorised to furnish this return and all its contents lists, statements, declarations, certificate annexed to it or filled with it are true, correct and complete and nothing has been concealed therein

Place :
Date :	[Signature]

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-XVII register/ computer

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

(Affix stamp of name and designation)

_______________________________________________________________________________________________

ACKNOWLEDGEMENT

Received from M/s____________________________ TIN _____________________a return in Form VAT-XV-D 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_____________

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Annexure to return in form VAT- XV-E

Date-wise details of Daily/Weekly/Monthly/Festival and Instant Draw during the period .... to ....

Sr. No.	Date of Draw	Name of organizer(s) of the draw	Number of draws on the date	Rate of lump-sum per draw	Tax Payable	Date of payment		TR no. or DD No. Alongwith the name of Bank	DCR No. and date (to be filled by the office)
Sr. No.	Date of Draw	Name of organizer(s) of the draw	Number of draws on the date	Rate of lump-sum per draw	Tax Payable	Due	Actual	TR no. or DD No. Alongwith the name of Bank	DCR No. and date (to be filled by the office)



				Total

Declaration

I, ______________ (name in CAPITALS), hereby, solemnly affirm that I am authorised to sign this annexure and the details given in it are true and correct.

Place :
Date :	[Signature]

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

Note : Separate statements to be attached for each type of draw.

Place :
Date :	Signature of the Dealer or his authorised agent