FORM VAT - G4
[See Rule 29(2), 35(1) & 59(3)]
CASH RECEIPT
To be issued to the person making payment under Haryana VAT Act., 2003
Book No. _______________
Receipt No. ________________
Date __________________
1 Name of Check Post / Barrier / Place of checking
2 Name of owner / incharge of Goods / Goods Carrier
3 Registration No. of the Goods Carrier
4 Amount Paid (in figures and letters) on account of
(a) Tax
(b) Advance Tax
(c) Penalty/security amount
(d) Superdari charges
5 Name and complete address of the owner /dealer on whose behalf money paid and TIN, under the Haryana VAT Act., 2003, if any
Signature of the person making the payment.
Signature of the Officer receiving the payment
Designation ..............