THE GOA VALUE ADDED TAX RULES, 2005 FORMS
-

(Counterfoil)

Form VAT - XII

[See rule 30(1) of the Goa Value Added Tax Rules, 2005]

REFUND VOUCHER

Voucher No.....................................

Refund Voucher for the refund of tax and/or penalty and/or interest

Under the Goa Value Added Tax Act, 2005(Act of 2005).

Refund payable to ...............

TIN

Issued by Commercial Taxes Office ........... Ward.

Date of order directing refund.........................................

Amount of refund: Rs...................................

Number in collection register showing the collection of amount regarding which refund is made:-

(Signed) ............................................

Designation ........................................

Dated:

(Seal Assessing Authority)

______________

Form VAT-XII

[See rule 30(1) of the Goa Value Added Tax Rules, 2005]

REFUND VOUCHER

Voucher No.................................

Refund Voucher for the refund of tax and/or penalty and/or interest Under the Goa Value Added Tax Act, 2005.

(Act 9 of 2005)

for being credited to the Bank Account of the dealer under no..................... at ..........................................

within three months of the date of issue.

(Bank & Branch)

To,

The Treasury/Sub-Treasury Officer,

The Agent or Manager of State Bank of India

_______________

Certified that with reference to the assessment record of....................................................

bearing TIN

(issued by the Commercial Taxes Office

of.......................................Ward), for the period from...............to ................., a refund of

Rs...............is due to..................................................

Certified that the amount of tax and /or penalty and /or interest concerning which this

refund is allowed has been duly credited to the Government Treasury.

Certified that the refund amount shall be debited to the following number of Accounts:

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

Certified that no refund order regarding the sum now in question has been previously

been granted and this order of refund has been entered in the original file of assessment

under my signature.

Please pay to ........................the sum of Rs......................................(in figures) Rupees

........................................................................................(in words)

Date :

(Signed).........................

(Seal Assessing Auathority )	Designation.......................
	Treasury /Sub-Treasury
Date of encashment in the	State Bank of India
	_____________________

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

Place.............................

Pay Rupees....................................................................only

		Treasury /Sub-Treasury of
The ................20	...................Office-in-charge of	State-Bank of India
		____________________

Received payment...............................
	Claimant's Signature............................
	Examined,
	Accoutant............................................

(a)	Classification:
	Tax.................
	Penalty................
	Interest.................

Third copy of the Refund Voucher is identical with the second copy and it is not reproduced here .

Payable at the..................................................
(Branch)

Treasury /Sub-Treasury State Bank of India

for Rs...........................

(in figures)

_____________________

(in words)