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THE GOA VALUE ADDED TAX RULES, 2005 FORMS
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Body

Form VAT - XXXIII

[See rule 58]

DECLARATION

(Under entry at serial number (53) of Schedule 'B' to the Goa Value Added Tax Act, 2005) (Goa Act 9 of 2005)

Year:..................... Date..............................

I.................. (name) ............(designation/status) of M/s ..............(name and address of Selling dealer) do hereby declare that:-

(1) .......................... Is the registered dealer holding TIN and that the registration granted to ...................... is in force as on this date.
                     

 

(2) The goods specified in the tax invoices and listed in the table herein below have been sold by ......................................................as industrial inputs/packing material covered under entry at serial number (53) of Schedule 'B' to the Goa Value Added Tax Act, 2005 (Goa Act 9 of 2005) as indented by the respective purchasing dealers for use by them in the manufacture of goods for sale.

Period from .......................... To .............................. quarter Year:

Sr. No. Name and Address of the purchasing dealer TIN Details of goods sold Invoice No. Date Amount in Rupees

(Rs.)

(1) (2) (3) (4) (5) (6) (7)
(i)            
(ii)            
(iii)            
(iv)            
(v)            
(vi)            
(vii) Total        

I hereby declare that whatever stated above is true to the best of my knowledge and belief.

Date: Signature:......
Place: Status:.....

N.B.: To be issued in duplicate. The 'Original' shall be forwarded b the selling dealer to the Assessing Authority and the 'duplicate' shall be retained by him for his record.