FORM 19

[See Rule 23(1) and (3)]

Application for grant/renewal of exemption certificate under rule 23 of the Chhattisgarh Value Added Tax Rules, 2006

To,

The Commercial Tax Officer

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

I,.................*Proprietor/*Partner/*Director/*Manager of the business known as...........being a dealer, holding registration certificate No...........under the Chhattisgarh Value Added Tax Act. 2005, whose only/*principal place of business for which the exemption certificate is required is within the jurisdiction of the Commercial Tax Officer.........and is situated............. *town/ *village ....... district.......tehsil........Municipal ward No......... (for municipal area only) do hereby apply:

*for grant of an exemption certificate in form 20 under rule 23(1) of the Chhattisgarh Value Added Tax Rules, 2006 for the period from ___ to ____.

*for renewal of the exemption certificate in form 20 dated...................(sent herewith) granted to me, the validity of which expires on...................

2. I hereby declare that no sales or purchases of any goods are likely to be made by me which will be liable to tax under the Chhattisgarh Value Added Tax Act. 2005.

3. I hereby declare that during the period from...................to...................I made no sales or purchases which were subject to tax under the said Act (for renewal only).

4. I seek grant/renewal of the exemption certificate for further reasons stated below :

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

(here state further reasons if any).

5. I undertake to send an intimation of any sale or purchase of taxable goods to the Commercial Tax Officer as required by sub-rule (2 ) of rule 23 of Chhattisgarh Value Added Tax Rules, 2006 and, furnish quarterly returns for the period commencing from the date of such sale or purchase and also pay into Government Treasury the tax payable according to such returns if I make any sale or purchase of such goods during the validity of exemption certificate in form 20 which may be granted to me*/which may be renewed.

Note : In case the application is for renewal, the application should be accompanied by exemption certificate.

*Strike out whichever is not applicable

ACKNOWLEDGMENT

Received an application in form 19 from _____________(name of the dealer) for grant/renewal of exemption certificate under rule 23 of the Chhattisgarh Value Added Tax Rules, 2006.