The Orissa Value Added Tax Rules, 2005 FORMS
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FORM VAT-204A

RETURN FOR UNREGISTRED DEALERS)

[See sub-rule (1) of rule 36]

01. Period covered by this return

	D	D	-	M	M	-	Y	Y	Y	Y
From

	D	D	-	M	M	-	Y	Y	Y	Y
TO

02. Name and Style of the business

Address

PHONE

FAX

03. If you have made no purchase and sale, mark this box " X "

PART-A

Particulars of purchases
		Price/ Value excluding Tax "A"	Tax paid under OVAT Act "B"
04	Purchase at 1% tax rate
05	Purchase at 4% tax rate
06	Purchase at 12.5% tax rate
07	Purchase of exempt goods
08	Purchase of schedule C goods
09	Any other purchase not specified above
10	Purchase / receipt from outside the state
11	Total value of the goods purchased / received

PART-B

Particulars of Sales
		Value of the goods sold
12	Sale of goods as specified in Schedule B to the Act
13	Sale turnover of works contractors
14	Sale of out still liquor
15	Sale of exempt goods
16	Sale of Schedule C goods
17	Total sale (sum of box 12 to 17)

DECLARATION

I (name) ______________________________ being (status) ____________ _____________________ of the above business do hereby declare that the information given in this return is true and correct to the best of my knowledge and belief.

Signature (With designation)	Date of declaration ____/____/______
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FOR OFFICIAL USE ONLY

Period covered under the return Date of receipt of the return Amount of Tax paid Mode of payment

_____________________________________________

___________________________________________

Signature with designation of the receiving officer.

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