FORM 4
[See Rule 8(2)]
To,
The ...................... (designation).
______________Circle
(1) I, __________ (Name of the dealer) ______________ (Address) holding TIN ___________ under the Madhya Pradesh Vat Act, 2002 hereby give the option for payment of a lump-sum in lieu of tax by way of composition for the year ____________. For that purpose I hereby declare that I am dealing in goods declared tax free under section 16 or/and goods being purchased by me from other registered dealers after payment to them of tax under section 9 of the said Act and/or goods manufactured by me using goods exempted under section 16 or/and purchased from other registered dealers after payment of tax under section 9 of the said Act.
(2) That my turnover in a year has ordinarily been less than rupees .one crore
(3) I shall furnish returns for the period specified in sub-rule (6) of rule 8 of the Madhya Pradesh Vat Rules, 2006 from the date on which the option given by me stands revoked under the provisions of sub-section (2) of section 11 of the said Act.
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ACKNOWLEDGMENT
(Affix seal if filled manually)
(Employee id: .....)