Form - 17-A
(See rule 20(2)(d))
Acknowledgement and Verification Form
1. Return Identification Number .......................................................................
2. Return ...........................................................................................................
3. Revised Return
4. TIN .............................................................................................................
5. Dealer's Business Name..................................................................................
6. Dealer's Name
7. Address .........................................................................................................
8. Act type ..................................................................................................
9. Period
10. Financial Year
11. Gross Turnover
12. Submission dated
13. Challan details:-
14. Enclosure list:-
1.
2.
3.
4.
Declaration
The particulars given above against return Identification Numner are true to the best of my knowledge and belief.