FORM VAT - B3 (OMITTED W.E.F. 1-1-2014 )

Indemnity Bond

[See rule 56(7) ]

Know all men by these presents that-

I/We, _________________ S/o ____________ registered dealer under the Haryana Value Added Tax Act, 2003, with Tax Payers Identification No. __________________, dated ______________, in the District of _________________ .

We/M/s ________________________ A firm/Company registered under the laws of India and having its registered office at _______________ are registered dealer under the Haryana Value Added Tax Act, 2003, with Tax Payers Identification No. ___________ in the District of _______________

(hereinafter called the "obligor") is/are held firmly bound unto the Governor of Haryana (hereinafter called the "Government") in sum of Rupees ___________________

___________________________ (in words) well and truly to be paid to the Government on demand and without demur for which payment to be well and truly made, I/We bind

myself/ourselves and my/our heirs, executors, administrators, legal representatives and

assignees, I/We bind myself/ourselves, our successors and assignees and the persons for the time being having control over my/our assets and affairs.

Signed this_________________ day of ________________ Two thousand ___________

Whereas rule 56(7) of the Haryana Value Added Tax Rules, 2003, requires that in the event of unused or filled form of declaration is lost while it is in the custody of the dealer to whom it was issued (herein after referred to as "user dealer") or in custody of the dealer to whom it was sent or in transit, the user dealer to furnish an indemnity bond to the assessing authority from whom the said declaration was obtained.

And whereas the Obligor herein is such user-dealer.

And whereas the Obligor has lost the declaration in Form bearing No. _______ which was unused or filled and was issued to him by ____________________( name and designation of the authority)*[ and was sent to _______________ (selling / consignor dealer)]

And whereas the goods mentioned below were covered or intended to be covered by the declaration.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Now the condition of the above written bond of obligation is such that the Obligor shall in the event of a loss suffered by the Government (in respect of which the decision of the Government or the authority appointed for the purposes shall be final and binding on the Obligor) as a result of the misuse of the declaration, pay to the Government on demand and without demur the said sum of Rupees ______________________________ (in words) and shall otherwise indemnify and keep the State Government harmless and indemnified against and from all liabilities incurred by the Sate Government as a result of the misuse of such declaration, then the above written bond or obligation shall be void and of no effect but otherwise shall remain in full force, effect and virtue. The obligor further undertakes to mortgage/charge the properties specified in the Schedule hereunder written by execution of proper deed of mortgage/charge for the payment of the said sum whenever called upon to do so by the assessing authority.

SCHEDULE

(Give details of properties mortgaged/charged)

And these presents also witnesseth that the liability of the Obligor hereunder shall not be impaired or discharged by reason of any forbearance, act or omission of the Sate Government or for any time being granted or indulgence shown by the State Government (or by reason of any change in the constitution of the Obligor in cases where the Obligor is not an individual).

The State Government agrees to bear the stamp duty, if any, chargeable on these presents.

In witness whereof the Obligor *has set his hand/*has caused these presents executed by

its authorized representatives, on the day, month and year above written.

Signed by the above named Obligor.

In presence of

1. ________________________

Accepted for and on behalf of the Governor of Haryana

In presence of:

1. _______________________

2. _______________________

Name and Designation of the Officer *

"*Strike out which is not applicable."