The Jharkhand Value Added Tax Forms , 2005
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FORM VAT 123

GOVERNMENT OF JHARKHAND

COMMERCIAL TAXES DEPARTMENT

[See Rule 16(1)]

Application for Grant of Instalment for Payment of Tax

Instructions:

1. Please ensure that the form is complete

2. Affix court fee stamp as prescribed.

3. Enclose copy of the order and notice of demand

4. This Form should be verified and signed by:

a. Proprietor, in case of Proprietorship concern

b. Managing Partner, in case of Partnership firm and where there is no Managing Partner, by all the partners if there is no registered partnership deed and in case of a registered partnership deed by any one of them.

c. Managing Director or authorized signatory, in case of a Company

d. Karta, in case of Hindu Undivided Family

e. Authorised Signatory, in all other cases

f. Or by the declared Business Manager

1.	Name of the Dealer	__________________________________
2.	Registration No. (TIN)	__________________________________
3.	Address
		Building Name/Number	___________________________
		Area/Road	___________________________
		Locality/Market	___________________________
		Pin Code	___________________________
		Telephone Number(s)	___________________________
		Fax Number(s)	___________________________
4.	Date of service of order		___ ___ / ___ ___ / ___ ___ ___ ___
			DD / MM / YYYY
5.	Section, under which order passed
6.	Tax period to which the order relates		___________________________
7.	Demand created in the order		___________________________
8.	Demand deposited, if any		___________________________
	(Enclose proof of payment)
9.	Bifurcation of demand due	Tax	___________________________
		Interest	___________________________
		Penalty	___________________________
		Other sums	___________________________
		TOTAL	___________________________
10.	Time period and intervals sought for payment of demand due
11.	Grounds for allowing to pay demand in instalments

Enclose additional sheet(s) in case you are not able to provide all details in this space

Enclose all documents/ evidence that you want considered regarding your application

Verification

I verify that the information given above and is its enclosures (if any) is true and correct to the best of my knowledge and belief and nothing has been concealed

Signature

Name

Designation

Date

Place