To

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

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

You are hereby informed that you are liable to pay a sum of rupees................. under section(s) ___________ of the Haryana VAT Act,2003 as tax (............), penalty (................ ) and interest (..............) vide order dated ................ . Copy of the order is enclosed.

2. You are hereby directed to pay the sum of Rs................(in figures)

................(in words), in the Treasury/Sub-Treasury/State Bank of India or its subsidiary at ................(place) within thirty days of receipt of this notice and furnish the proof of payment to the undersigned within ten days from the date of payment.

3. A Challan form VAT – C1 is enclosed for the purpose.