FORM VAT-404 Omitted w.e.f. 01-07-2017

INDEMNITY BOND FOR LOSS OF WAY BILL.

[Refer sub-rule (7) of rule 80]

..............................residing at ------------------------------------------- P.O. .................................... P.S........................... Dist ............................................................, Proprietor/Partner/ (Managing) Director/Manager/Principal Officer/ Authorised officer of the Business known as ..............................situated at ......................................... and possessing a Tax-payers's Identification number bearing TIN ............................... in the State of Orissa under the Orissa Value Added Tax Act, 2004 , do hereby declare that the way bill form bearing no........... issued to me/us by the Sales Tax Officer / Assistant / Deputy / Joint Commissioner of Sales Tax, .............................. Circle/Range, on ..............................is lost / destroyed / stolen,

(i) from my custody, before being filled in and signed by me; or

(ii) from my custody, after being filled in and signed by me, before despatch to the selling dealer/consignee, namely ...............................

(iii) in transit, after being duly filled in and signed by me and despatched to the selling dealer/consignee, namely....................................

(Strike out whichever is not applicable)

And I, the aforesaid Sri ........................ do hereby undertake to hold harmless and to indemnify the Government against any loss arising out of the aforesaid loss of way bill form.

And I bind myself, my heirs, executors, administrators and assignees and each one of the other person having any share, title or interest in the aforesaid business and his heirs, executors, administrators and assignee jointly and severally for holding harmless and indemnifying the Government for any such loss as aforesaid.