TAXES DEPARTMENT

GOVERNMENT OF KERALA

LIABILITY CERTIFICATE

FORM No.1EE

See KERALA VALUE ADDED TAX RULES, 2005

(Not Transferable)

This is to certify that M/s / Sri. / Smt. ___________________________________ (Trade Name________________________ ) is a registered dealer under the provisions of the Kerala Value Added Tax Act, 2003.

a. Name & Address of Awarder :

b. TIN of Awarder (if any):

c. Nature of contract (Specify):

d. Work order No. and date :

e. Work Site Address:

f. Period of work:

g. Gross Contract Amount:

h. Payment received up to previous year:

i. Balance payment : (auto calculate)

j. Sub Contract if any:

k. Whether Compounding opted for the contract :

l. Nature of Compounding opted : (Annual / work wise)

m. Rate of Compounding :

The dealer is permitted to receive contract receipts without deducting VAT

or

The dealer is permitted to receive the contract receipts after deducting VAT @ ___(3% or 4%. or 12.5%)

Tax due on Interstate purchase Rs. ________

(Seal)