THE RAJASTHAN VALUE ADDED TAX RULES, 2006 - FORMS
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Body

Form VAT - 22

[See Rule 27(1)(d) and 27(2)(d)]

Application for refund by a person or unregistered dealer

AC/CTO/ACTO	TIN
Circle/Ward

Name of person/Dealer

2. Address

2.1	Bldg No/Name/ Area /
2..2	Town/City
2..3	District
2..4	Pin Code
2..5	e-mail Id
2..6	Telephone/Mobile Number

3. Details of Bank:

3.1 Name of the Bank in which refund is sought
3.2 Name of the Branch
3.3 Account No.
3.4 Account Type
3.5 IFSC No. of the Branch

4. Amount of Refund claimed and reason(s) thereof

a.	Particulars:-
(i)	Amount of refund
(ii)	Period
(iii)	Date of order, if any DD/MM/YYYY
(iv)	Reason(s) of refund:

or/ and

b.	as a result of order of competent officer/authority/court
(i)	Amount of refund
(ii)	Name of the Authority
(iii)	Date of order, DD/MM/YYYY

5. Details of deposit/deduction:

a.	If deposited
(i)	Amount deposited
(ii)	Date of deposit, DD/MM/YYYY
(iii)	GRN/CIN No

or/ and

b.	If deducted by works contract awarder
(i)	Name of the awarder
(ii)	Awarder Identification No.
(iii)	Date of award, DD/MM/YYYY
(iv)	Amount deducted
(v)	VAT 41 No.
(vi)	GRN/CIN No

Place :	Signature
Date :	Name and Status

Verification

I certify that the above information and its enclosures (if any) are true and correct to the best of my knowledge and belief and nothing has been concealed

Place :	Signature
Date :	Name and Status