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THE KERALA VALUE ADDED TAX RULES, 2005 - Forms
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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)]

Tax payers Identification No
                   

 

To

The Registering/ Assessing Authority

(with Office Address) Central Sales Tax No.
                   

 

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

TIN Of supplie dealer

Name of the goods purchased Schedule No. & Entry no, HSN Code Rate of Tax Particulars of

Invoice

Purchase value of inputs of goods in relation to goods exported Input tax paid
Bill No Date
(1) (2) (3) (4) (5) (6) (7) (8) (9)
                 
TOTAL              

PART- B : GOODS EXPORTED IN RELATION TO REFUND FOR INPUTS CLAIMED AS PER PART - A

Name of the goods Exported

Schedule No. & Entry No, HSN Code Rate of Tax Export Invoice Exporter' copy/ Export promotion copy of the shipping bill/Air consignment Note etc. Export Value in India Currency
No. Date No. Date
(1) (2) (3) (4) (5) (6) (7) (8) (9)
                 
TOTAL              

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).

Place :

Date:

Seal

 

  Name, Signature & Status f the applicant

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