THE HARYANA VALUE ADDED TAX - FORMS
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FORM VAT-D1

Form of Declaration

(Part A) $

[See rule 17(1)]

Office of issue ..............................

Date of issue .................................

Name of the purchasing dealer to

whom issued along with his TIN ..............................................................................

Date from which registration is valid..................................

Serial No. ...............

To,

SEAL OF issuing authority

........................................(Seller)

..........................................................

Certified that the goods supplied by you during the period from......... to........ valued at Rs. .............. (amount) as per tax invoices listed below are for, –

*(i) use in the manufacture of goods (including packing of goods manufactured by me/us) for sale;

*(ii) use in the telecommunication network;

*(iii) use in mining;

*(iv) use in generation or distribution of power; or

*(v) packing of goods used in any of the aforesaid business activities,

*(vi) use in execution of a works contract in respect of which composition of tax under section 9 of the Act has been made and is in force in my/our case,

(*Strike out whichever is not applicable.)

and the said goods are covered by my/our registration certificate TIN ................ dated ............. issued under the Haryana Value Added Tax Act, 2003.

Particulars of tax invoice(s)

Serial No.	Date	No.	Amount

The above statements including the details of the tax invoices given above are true and nothing has been concealed therein.

Name and address of the

purchasing dealer with stamp

Name of the person signing the

declaration

Signature ...........................

Date................

Status ................

$ Note:-To be furnished by the purchasing dealer to the selling dealer who shall furnish it to the assessing authority, when required by it to do so.

FORM VAT-D1

Form of Declaration

(Part B) $

[See rule 17(1)]

Office of issue ..............................

Date of issue .................................

Name of the purchasing dealer to

whom issued along with his TIN ..............................................................................

Date from which registration is valid..................................

Serial No. ...............

To,

SEAL OF issuing authority

........................................(Seller)

..........................................................

Certified that the goods supplied by you during the period from......... to........ valued at Rs. .............. (amount) as per tax invoices listed below are for, –

*(i) use in the manufacture of goods (including packing of goods manufactured by me/us) for sale;

*(ii) use in the telecommunication network;

*(iii) use in mining;

*(iv) use in generation or distribution of power; or

*(v) packing of goods used in any of the aforesaid business activities,

*(vi) use in execution of a works contract in respect of which composition of tax under section 9 of the Act has been made and is in force in my/our case,

(*Strike out whichever is not applicable.)

and the said goods are covered by my/our registration certificate TIN ................ dated ............. issued under the Haryana Value Added Tax Act, 2003.

Particulars of tax invoice(s)

Serial No.	Date	No.	Amount

The above statements including the details of the tax invoices given above are true and nothing has been concealed therein.

Name and address of the

purchasing dealer with stamp

Name of the person signing the

declaration

Signature ...........................

Date................

Status ........................

$ Note:-To be retained by the purchasing dealer who shall produce it before the assessing authority, when required by it to do so.

FORM VAT-D1

Form of Declaration

(Part C) $

[See rule 17(1)]

Office of issue ..............................

Date of issue .................................

Name of the purchasing dealer to

whom issued along with his TIN ..............................................................................

Date from which registration is valid..................................

Serial No. ...............

To,

SEAL OF issuing authority

........................................(Seller)

..........................................................

Certified that the goods supplied by you during the period from......... to........ valued at Rs. .............. (amount) as per tax invoices listed below are for, –

*(i) use in the manufacture of goods (including packing of goods manufactured by me/us) for sale;

*(ii) use in the telecommunication network;

*(iii) use in mining;

*(iv) use in generation or distribution of power; or

*(v) packing of goods used in any of the aforesaid business activities,

*(vi) use in execution of a works contract in respect of which composition of tax under section 9 of the Act has been made and is in force in my/our case,

(*Strike out whichever is not applicable.)

and the said goods are covered by my/our registration certificate TIN ................ dated ............. issued under the Haryana Value Added Tax Act, 2003.

Particulars of tax invoice(s)

Serial No.	Date	No.	Amount

The above statements including the details of the tax invoices given above are true and nothing has been concealed therein.

Name and address of the

purchasing dealer with stamp

Name of the person signing the

declaration

Signature ...........................

Date................

Status ..............

$ Note:-To be furnished by the purchasing dealer to the selling dealer who shall retain it in his record.