THE GOA GOODS AND SERVICES TAX FORMS 2017
INPUT TAX CREDIT

Form GST ITC -02

[See Rule - 41(1)]

Declaration for transfer of ITC in case of sale, merger, demerger, amalgamation, lease or transfer of a business under subsection (3) of section 18

1.	GSTIN of transferor
2.	Legal name of transferor
3.	Trade name, if any
4.	GSTIN of transferee
5.	Legal name of transferee
6.	Trade name, if any

7. Details of ITC to be transferred

Tax	Amount of matched ITC available	Amount of matched ITC to be transferred
1	2	3
Central Tax
State Tax
UT Tax
Integrated Tax
Cess

8. Particulars of certifying Chartered Accountant or Cost Accountant

a) Name of the Firm issuing certificate

b) Name of the certifying Chartered Accountant/Cost Accountant

c) Membership number

d) Date of issuance of certificate to the transferor

e) Attachment (option for uploading certificate)

9. Verification

I __________________________________________ hereby solemnly affirm and declare that the information given hereinabove is true and correct to the best of my knowledge and belief and nothing has been concealed there from.

Signature of authorized signatory _______________________________________

Name

_______________________________________

Designation/Status ____________________________

Date --- dd/mm/yyyy