FORM VR III

Register of Forms D-III/D-XI received under the Bihar Value Added Tax Rules, 2005

(to be furnished separately with regard to Form D-III and Form D-XI)

[See Rules 10 and 19(3A)]

1. Name and style of the business :      

2. Taxpayer identification number of the purchasing dealer :      

3. Period to which the statement, relates      

4. Name of the Circle to which the statement relates :      

5. *Total number and value of forms received during the quarter :      

6. Total value of purchases of goods specified in Schedule IV :      

7. Total Sale effected during the quarter :      

8. Total tax deposited during the quarter :      

Remarks : __________________________________________________________________

____________________________________________________________________________           

Verification

I do hereby declare that the above particulars are correct and complete to the best of my knowledge and belief.

*Funish, as an Annexure, dealerwise utilization statement indicating therein details of sales effected during the period