The Nagaland Value Added Tax Rules, 2005 - FORMS
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THE NAGALAND VAT RULES, 2005

FORM VAT-11

[See rule 54 (10)]

Form of return to be furnished by a Lump Sum Retailer

Original/Duplicate copy of return for the quarter ended on:

DD	MM	YY

1. Dealer's identity

Name and style of business

M/s ..........

Address

Contact No.

TIN

Economic Activity Code

4. Details of tax deposited

Sl. No	Name of treasury where tax deposited or Bank on which DD/Pay order drawn or Office from where RAO issued, etc	Treasury receipt (TR)/DD/PO/ RAO				For office use
		Type of Instrument	No.	Date	Amount	DCR No.	Date


	Excess paid brought forward from last return
	Total

	[Signature of Authorized Person]
	Date:

DECLARATION

I, ................................................ (name in CAPITALS), hereby, solemnly affirm that I am authorized to furnish this return and all its contents including tables, lists, statements, declarations, certificates and other documents appended to it or filed with it are true, correct and complete and nothing has been concealed therein.

Place:

Date: [Signature]

Status: Tick applicable [Karta, proprietor, partner, director, president, secretary, manager, authorized officer]

______________________________________________________________________________________________

(For use in the Office of the assessing authority)

(1) Date of data entry in VAT-21 register/ :

Computer

(2) Signature of the official making the data entry :

(Affix stamp of name and designation)

(3) Signature of the assessing authority with date :

(Affix stamp of name and designation)

______________________________________________________________________________________________

Acknowledgement

The undersigned below acknowledges having received the original of this return on the date mentioned below:

(1) Date of receipt of return:	(2) [Signature with stamp of name & designation of receipt clerk]

_______________________________________________________________________________________________

ANNEXURE-1

List of purchases of taxable goods purchased from VAT dealers and other retailers in the State by a lump sum retailer for the quarter ended

DD	MM	YY

Name and TIN of the registered dealer furnishing the list

Name and style of business

M/s

TIN

Economic Activity Code

Sl. No.	Name and address of the selling dealer	TIN	Sale Invoice No.	Date	Value of goods
(1)	(2)	(3)	(4)	(5)	(6)


Total

DECLARATION

I, .......................................... (name in CAPITALS), hereby declare that the contents of the above list and table are true and correct and nothing has been concealed therein.

Place:	Signature of authorized signatory
	Name: ....................................
Date:	Status: ....................................

Status: Tick applicable [Karta, proprietor, partner, director, president, secretary, manager, authorized officer]