The Jammu and Kashmir Value Added Tax Form, 2005.
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FORM VAT-57

[See rule 67 (13) & 72(9)]

REFUND APPLICATION

The Assessing Authority

.....................................

I,________________________________son of __________________________ R/o ________________________________________ on behalf of myself/ partner/proprietor of M/s_______________________________________ apply for refund of Rs.....................................................furnish the following particulars:-

1.	Full name and address of the Dealer/person who own goods
2.	Date of seizure of good
3.	Date of auction of the goods
4.	Particulars of goods	Invoice No. and date	GR No.and date
		_______________________________
5.	Name of the consignor (if applicable)

6.	Authority who seized the goods with Reference to provisions of the Act Under which seized.

Dated

Signature of the applicant.