THE KERALA VALUE ADDED TAX RULES, 2005
FORM NO. 21C
APPLICATION FOR REFUND OF INPUT TAX
[IN THE CASE OF EXPORT ONLY]
[See Rule 47(1)]
To
The Registering/ Assessing Authority
I/We............................ do hereby apply for refund of Rs....................... Rupees ............................ (In words) under section 13 of the Kerala Value Added Tax VAT Act, 2003 in respect of the INPUT TAX PAID on the purchase of goods in relation to goodsexported.
PART- A : PURCHASE OF GOODS (INPUTS) (INCLUDING CAPITAL GOODS) IN RELATION TO THE GOODS EXPORTED
Invoice
PART- B : GOODS EXPORTED IN RELATION TO REFUND FOR INPUTS CLAIMED AS PER PART - A
Total Refund Claimed Rs...................... Rupees........................................(in words)
DECLARATION
I/We .............. (Name & address) do hereby certify that :-
1. Input tax credit had not been claimed for the above amount of refund on such purchases for any prior return period.
2. Refund adjustment had not been availed of in respect of the above amount of refund towards any dues on any prior occasion.
3. Stock Register has been maintained in accordance with rule 58 (1)(vi).
Date:
ENCLOSURES
1. Copy of the Exporter"s copy or Export Promotion copy of the Shipping Bill
2. Certificate from the Bank to prove receipt of export sale proceeds
3. Declaration in Form No.21 J obtained from the supplier-dealer who collected tax in respect of which above refund is claimed
4. H Form declarations, if any, obtained.
5. Copies of the Form No. 25 B submitted.
6. Others (specify).
FOR OFFICE USE