THE HIMACHAL PRADESH VALUE ADDED TAX RULES, 2005. FORMS
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Form VAT-XV-D

[See rule 46(4)]

Form of return to be furnished by a Bricks Kiln owner

Original/Duplicate copy of return for the quarter ended on:

1. Dealer's identity

Name and style of business

M/s

Address

Contact No.

TIN

Economic Activity Code

2	Category and capacity of kiln(s), the lumpsum payable and in case of option during the year and addition of new kiln(s) during the year, the month from which the lumpsum is payable.	Kiln number	Cate-gory	Number of Ghoris	Lump-sum payable	Month from which lump sum payable

		1^st Kiln
		IInd Kiln
		IIIrd Kiln
		IVth Kiln
				Total

3. Details of tax deposited

Sr. No.	Name of treasury where tax deposited or Bank on which DD / Pay order drawn	Treasury receipt(TR)/DD/PO				For office use
		Type of instrument	No.	Date	Amount	DCR No.	Date



	Excess paid brought forward from last return
	Total

4. Account of forms printed under the Government authority.

Sr.

No.

Type of Form

Opening stock at the beginning of the return period

Blank forms received or authenticated during the return period

Forms used during the return period

No.

Aggregate of amount of transactions for which forms used

(1)

5. Aggregate price of goods purchased in the course of Inter-State trade against 'C' Forms

List LP-1 appended

Declaration

I, _____________(name in CAPITALS), hereby, solemnly affirm that I am authorised to furnish this return and all its contents including tables, lists, statements, declarations, certificate and other documents appended to it for filled with it, are true, correct and complete and nothing has been concealed therefrom.

Place :
Date :	[Signature]

Status : (Tick) applicable [Karta, proprietor, partner, director, president, secretary, manager, authorised officer]

_______________________________________________________________________________________________

(For use in the office of the Assessing Authority)

(1) Date of data entry in the office record/Computer.

(2) Signature of the official making the data entry:

(Affix stamp of name & designation)

(3) Signature of the assessing authority with date:

(Affix stamp of name & designation)

_______________________________________________________________________________________________

ACKNOWLEDGEMENT

Received from M/s____________________________ TIN _____________________a return in Form VAT-XV-D of tax payable under section 20 for the month of______________alongwith a list in Forms LS-2.

Assessing Authority/

Excise and Taxation Inspector,

(when posted in circle outside District Headquarters)

Circle_________District_______.

(SEAL)

Date_____________