Form A-XIV

Application for refund under sub-rule (2A) of rule 43 of the Bihar Value Added Rules, 2005

To

The ………………………… of Commercial Taxes, ………………… Circle.

I, …………………… name), son of ………………… (full name) on behalf of the dealer/ any other person whose particulars are detailed below, hereby apply for refund of excess tax/penalty.

1. Taxpayer Identification Number. ………………………………

2. Name of the dealer ……………………………

3. Style of business ………………………………

4. Location of business …………………………

5. Period to which refund relates ………………………………

6. Amount of refund claimed ……………………

7. Grounds of refund (unadjusted ITC* or Export*)

8. Manner of refund preferred …………………………

(i) Payment order

(ii) Adjustment order

(iii) Period against which adjustment is prayed

(iv) Payable at Treasury

I, ………………… the petitioner, named in the above petition, do hereby declare that what is stated herein is true to the best of my knowledge and belief and that no application for refund of the above amount has been made by me or on my behalf before this date.

*Strike out whichever is not applicable."