FORM 21

[See rule 24(1)]

Application for grant of permission to submit return for different period .

To,

The Commercial Tax Officer

.................................Circle

I,................*Proprietor/*Manager/*Partner/*Director of the business known as...................... olding registration certificate No........... .....under the Chhattisgarh Value Added Tax Act. 2005 whose only/*principal place of business within the jurisdiction of Commercial Tax Officer......... (circle) is situated at....town / village..... District........ Tehsil........ Municipal ward No.............(for Municipal areas only) do hereby apply for permission to file an annual return under the proviso to sub-section (1) of section 19 of the said Act, read with rule 24 of the Chhattisgarh Value Added Tax Rules, 2006 and for the said purpose I am furnishing the following particulars :

(1) Place of business in respect of which permission is applied for ,-

(i) Name and style of the business ___________________________

(ii) Address of the place of business _________________________

(iii) Registration certificate No. _____________________________

(2) Year for which permission is applied for __________ (From _________ to_______________ )

(3) Gross turnover and tax assessed for the latest previous year.

(i) year ___________________________ (From ____________ to __________________ )

(ii) Gross turnover Rs.__________________

(ii) Tax assessed_________________

(iii) Assessment case No. _______,

(iv) order of assessment dated ________,

passed by Shri ___________________ Commercial Tax Officer ___________________Circle/ Shri _____________ Assistant Commissioner of CommercialTax__________________________

(4) Gross turnover and tax payable according to the returns for the preceding year,-

(i) Year __________________ (From __________to __________)

(ii) Gross turnover Rs.______________________.

(iii) Tax payable Rs.______________________ Tax paid Rs.__________________.