FORM VAT-611
APPLICATION FOR ISSUE OF CLEARANCE CERTIFICATE
[Refers sub-rule (1) of rule 129]
.
04.
(i) Name of the applicant (In block letter)
(ii) Status with reference to the business
(iii) Permanent address
(iv) Present address
(v) Name and address of the Principal place of business
(vi) Name and address of the additional place of business
(vii) Purpose for which clearance certificate is required.
(viii) Arrear of Tax/ Interest/ penalty, if any and if so, the details of such arrears.
(ix) The tax period upto which return has been filed.
I ________________ son/daughter /wife of ______________________________ (status) ___________________________ of M/s._____________________________________ at _________________________ bearing TIN/SRIN________________________do hereby
declare that the information furnished above are true and correct to my knowledge and belief.
Date__________________________
Seal
(Status)