THE HARYANA GOODS AND SERVICES TAX FORMS 2017
INSPECTION OR SEARCH AND SEIZURE

FORM GST INS-04

BOND FOR RELEASE OF GOODS SEIZED

[See rule 140(1)]

I.................of....................hereinafter called "obligor(s)" am held andfirmly bound to the President of India (hereinafter called "the President") and/or the Governor of ................(State) (hereinafter called "the Governor") inthe sum of...........................rupees to be paid to the President / the Governor for which payment will be made. I jointly and severally bind myself and myheirs/ executors/ administrators/legal representatives/successors and assigns by these presents; datedthis...................day of....................

WHEREAS in accordance with the provisions of sub-section (2) of section 67, the goods have been seized vide order number ......................dated................. having value ................rupees involving an amount of tax of .................... rupees. On my request the goods have been permitted to be released provisionally by the proper officer on execution of the bond of value .....................rupees and a security of.................. rupees against which cash/bank guarantee has been furnished in favour of the President/ Governor; and

WHEREAS I undertake to produce the said goods released provisionally to me as and when required by the proper officer duly authorized under the Act.

And if all taxes, interest, penalty, fineand other lawful chargesdemanded by the proper officer are duly paid within ten days ofthe date of demand thereof being made in writing by the said proper officer, this obligation shall be void.

OTHERWISE and on breach or failure in the performance of any part of this condition, the same shall be in full force:

AND the President/Governor shall, at his option, be competent to make good all thelosses and damages from the amount of the security deposit or by endorsinghis rights under the above-written bond or both;

IN THE WITNESS THEREOF these presents have been signed the dayhereinbefore written by the obligor(s).

Date :	Signature(s) of obligor(s).

Place :

Witnesses

(1) Name and Address

(2) Name and Address

Date

Place

Accepted by me this.............................day of .........................(month).........................(year)................................. (designation of officer)for and on behalf of the President /Governor.

(Signature of the Officer)