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THE GOA VALUE ADDED TAX RULES, 2005 FORMS
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Body

Form VAT - XXXIV

[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 Purchasing 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 Purchased by him 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) for use in the manufacture of goods at our factory not for resale.

TABLE

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

Sr. No. Name and Address of the selling dealer TIN Details of goods Purchased 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 Purchasing dealer to the Assessing Authority and the 'duplicate' shall be retained by him for his record.