The Gujarat Value Added Tax Rules, 2006
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FORM 210B

(see sub-rule (1) of rule 28B)

Application for permission to pay lump sum tax in lieu of tax under section 14C of the Gujarat Value Added Tax Act, 2003.

To,

The Commercial Tax Officer

______________________

I, hereby submit my application for grant of permission to me / Ms/ ____________________ __________________________________________ to pay lump sum tax under section 14C of the Gujarat Value Added Tax Act, 2003.

The Details of my business are as under :

1.	Name of the
	Applicant ________________________________
2.	Name of the Firm (Business)
	_________________________________________
3.	Address
	_________________________________________
4.	Registration Number under Gujarat Value Added Tax Act, 2003
	_________________________________________
5.	Registration Number under the Central Sales Tax Act, 1956
	_________________________________________
6.	Nature of Business
	_________________________________________

I may, be granted permission to pay lump sum tax for the period commencing from _______________ and ending on the 31st March _________________.

Place _________________	Signature ________________
Date __________________	Designation ______________