Maharashtra Value Added Tax Rules, 2005 FORMS
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Body

FORM 421

(See rule 40A (2))

Certificate of amount collection at source towards tax to be given to the person/dealer under sub-rule (1) of rule 40A of the Maharashtra Value Added Tax Rules, 2005.

Certificate No: - ..........................

Dated: ................................

1 Designation and full address of the Collection Authority



2 TIN/PAN/TAN of the Collection Authority
3 Name and full address of the person, dealer from whom amount towards tax is collected.


4 TIN/PAN/TAN of the dealer/person from whom amount is collected.
5 Particulars of the amount collected
1) Particulars of goods (Sand/Other)
2) Quantity of Sand/Goods
3) *Reference number and date (Sand Auction reference No. and date / Sr. No. and date of Airway bili/Railway Receipts/Bill of Entry/Lorry Receipts)
4) *Value of Auction / goods
5) Amount collected
6) The date on which amount collected has been paid into Government Treasury

Certified that the amount collected at source as above have been remitted by me in the Government Treasury/Bank in accordance with rule 40A (1) of the Maharashtra Value Added Tax Rules, 2005 and that the particulars furnished above are true and correct to the best of my knowledge.

Place	Signature of the authority collecting amount towards tax.
Dated

* Value of Auction is applicable to Sand auction purchaser and Value of goods is applicable to others.