FORM VAT - G9
[See Rule 41(4) & 43(1)]
Refund Adjustment order
Voucher No. ____________________
Date ____________
1 Name of dealer or person to whom issued
__________________________________
2 TIN (In case of dealer registered under the Act.)
3 Amount of refund due
(Rupees ___________________________
4 Date of order quantifying the refund amount.
5 Details of amount deducted, if any on account of any demand outstanding against the applicant
Amount
Demand No. and Date
Voluntary Tax for the period
6 Net refundable amount in figures and words (3 – 5)
(In Words _______________________________
(In Figures ______________________________
Signature and Stamp of Receiving Dealer
Signature and Stamp of issuing Officer
Date _____________
Part – II
(Endorsement)
Certified that the above refund adjustment order has been endorsed by me/us to M/s __________________________________________ Address ______________________________ ________________________ who is registered under the Haryana Value Added Tax Act., 2003 with TIN ___________________________
Signature and Stamp of the Dealer to whom endorsed
Part – III
This refund adjustment order is submitted for adjustment against
(a) my/our tax liability for the period ____________________________________
(b) Tax payable against additional demand created vide order dated ____________ by Sh. ________________________AETO/ETO/DETC for the year __________________
Adjustment allowed. Necessary entry has been made in register VAT - G11.
Signature Signature of District
in-charge with Stamp
Refund Clerk
Signature and Stamp of the Dealer who submitted the RAO for adjustment
Date -----------------------