THE ODISHA GOODS AND SERVICES TAX FORMS 2017
ASSESSMENT

Form GST ASMT - 05

[See rule 98(4)]

Furnishing of Security

1. GSTIN

2. Name

3. Order vide which security is prescribed

Order No.

Order date

4. Details of the security furnished

Sr. No.	Mode	Reference no. / Debit entry no. (for cash payment)	Date	Amount	Name of Bank
1	2	3	4	5	6

Note - Hard copy of the bank guarantee and bond shall be submitted on or before the due date mentioned in the order.

5. Declaration -

(i) The above-mentioned bank guarantee is submitted to secure the differential tax on the supply of goods and/or services in respect of which I/we have been allowed to pay taxes on provisional basis.

(ii) I undertake to renew the bank guarantee well before its expiry. In case I/We fail to do so the department will be at liberty to get the payment from the bank against the bank guarantee.

(iii) The department will be at liberty to invoke the bank guarantee provided by us to cover the provisional assessment in case we fail to furnish the required documents/ information to facilitate finalization of provisional assessment.

	Signature of Authorized Signatory
	Name
	Designation / Status -----------
	Date------------

Bond for provisional assessment

(Rule 98(3) & 98(4))

I/We.........................of..........................hereinafter called "obligor(s)", am/are held and firmly bound to the President of India (hereinafter called "the President"/ the Governor of..................(State) (hereinafter called the "Governor") in.......................... the sum of............... rupees to be paid to the President/ Governor for which payment will and truly to be made. I/We jointly and severally bind myself/ourselves and my/our respective heirs/ executors/ administrators/ legal representatives/successors and assigns by these presents; Dated this..................day of..................;

WHEREAS final assessment of Integrated tax/ central tax/ State tax / Union territory tax on................... (name of goods/services or both-HSN/SAC:__________) supplied by the above bounded obligor from time to time could not be made for want of full information with regard to the value or rate of tax applicable thereto;

and whereas the obligor desires that the provisional assessment in accordance with the provisions of Section 60 be made;

AND WHEREAS the Commissioner has required the obligor to furnish bank guarantee for an amount of....................rupees endorsed in favour of the President/ Governor and whereas the obligor has furnished such guarantee by depositing with the Commissioner the bank guarantee as aforementioned;

The condition of this bond is that the obligor and his representative observe all the provisions of the Act in respect of provisional assessment under section 60;

And if all dues of Integrated tax/ Central tax/ State tax/ Union territory tax or other lawful charges, which shall be demandable after final assessment, are duly paid to the Government along with interest, if any, within thirty days of the date of demand thereof being made in writing by the said 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 virtue:

AND the President/ Governor shall, at his option, be competent to make good all the loss and damages from the amount of bank guarantee or by endorsing his rights under the above-written bond or both;

I/We further declare that this bond is given under the orders of the Central Government/ State Government for the performance of an act in which the public are interested;

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

Signature(s) of obligor(s).
Date :
Place :
Witnesses
(1) Name and Address	Occupation
(2) Name and Address	Occupation
Date
Place
Witnesses
(1) Name and Address	Occupation
(2) Name and Address	Occupation

Accepted by me this......................day of (month)........................(year)

...........................of..................(Designation)

for and on behalf of the President of

India./ Governor of......................(state)".