The Orissa Value Added Tax Rules, 2005 FORMS
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FORM VAT-101B

ADDRESS OF BRANCH OFFICES / GODOWNS LOCATED OUTSIDE ORISSA.

[ See clause (b) of sub-rule (9) of rule 15 ]

01. Name and style of the business:

02. Address:

03. Name of the applicant:

Status of business

(Mark v where applicable)

Branch office

Godown (operated by C & F Agent/consignment Agent)

04. State ______________________

ADDRESS ________________________________________________________________

_________________________________________________________________________

__________________________________________________________________________

Pin Code ___________________ Telephone ___________________ Fax _______________

R.C. No. under the State Act. _____________________________________________

R.C. No. Under the C.S.T. Act. ____________________________________________

Signature

Designation with relation to the business.

Seal	Date ________________________________

V E R I F I C A T I O N

I _______________________ son/ daughter / wife of ___________________________

status _________ of the aforesaid business do hereby solemnly affirm that the particulars

given in this form are true and correct to the best of my knowledge and belief.

Signature

Seal	Date : ___________________________