FORM 5

(See Rule 5 (28)

Assessment No.

To..........................................

..........................................

(Dealer)

Take notice that at the ........ Year ending/the period upto and inclusive of the date of discontinue of busines after deducing the payments made by you a sum of Rs .............. (Rupees.........) (in words) only is due and payable by you, being the amount/balance of amount collected by you by way of tax or taxes under Section 22 of the Kerala General Sales Tax Act, 1963. The said sum of Rs (Rupees .....) (in words) shall be paid within thirty days from the date of service of this notice by crossed cheque or by crossed demand draft in favour of the undersigned or by remittance into the Government Treasury at ........ Failing which the amount will be recovered as if is were an arrear of land revenue and/or as if it were a fine imposed by a Magistrate and you will also be liable to pay the penalty prescribed under Sub-section (3) of Section 23 of the Act.

Place : ..........................

Date : ...........................

Note : Where payment is made by cheque, the cheque shall be crossed and shall be such as is receivable by the Government Treasury concerned.