The Uttar Pradesh Value Added Tax Rules, 2008, FORMS
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Body

FORM - D

Department of Commercial Taxes, Government of Uttar Pradesh

[See Sl. No. 6(a), 9(a), 10(a), 11(a) of Schedule-IV of UPVAT Act, 2008]

Certificate of goods used in the process of manufacture of taxable goods

Authentication by assessing officer with signature, Name & Seal

(Original - for Assessing Authority)

Book No...................................................................

Serial No...........................

Name and Address of Dealer/ Person to whom Interest is due

TIN

w.e.f.

Assessment Year

Month ending on

Name and Address of seller

TIN

w.e.f.

Details of purchases

Sl. No.	Name of month	Name of commodity	Measure/Quantity	Amount in sale/tax invoice	Amount of tax	Total
1	2	3	4	5	6	7

Total in words
Total in fingure

DECLARATION

I.........................................................................................................Status......................do hereby declare that the particulars given above and on the back of this certificate are complete and true to the best of my knowledge and belief.

Place -	Signature
Date -	Name & Designation of authorized signatory
Seal

Note : 1) This certificate shall be signed by the person mentioned in column 2 of the table given in the Rule32(6) of UPVAT Rules, 2008.

2) This certificate shall be in triplicate.

3) This certificate shall be countersigned by the assessing authority.

Annexure

List of purchases made against sale/ tax invoice :

Sl. No.	Name and address of selling dealer	TIN	Sale/Tax invoice No.	Date of sale/Tax invoice	Description of commodity			Taxable value of goods	Amount of Tax charged	Total amount of invoice
1	2	3	4	5	6	7	8	9	10	11
1
2
3
4
5

Name and signature of authorized signatory

Date