The Chhattisgarh Value Added Tax Rules, 2006. - FORMS
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Body

Form - 17-A

(See rule 20(2)(d))

Acknowledgement and Verification Form

1. Return Identification Number .......................................................................

2. Return ...........................................................................................................

3. Revised Return …………………………………

4. TIN .............................................................................................................

5. Dealer's Business Name..................................................................................

6. Dealer's Name ……………………………………

7. Address .........................................................................................................

8. Act type ..................................................................................................

9. Period …………………………………………………

10. Financial Year …………………………………………

11. Gross Turnover………… ………………………………

12. Submission dated ………………………………………

13. Challan details:-

S.No.	Challan No.	Date	Amount	Name of the Bank	Branch

14. Enclosure list:-

1. …………………

2. …………………

3. …………………

4. …………………

Declaration

The particulars given above against return Identification Numner …………… are true to the best of my knowledge and belief.

Place: ……………	Signature of Dealer …………
Dated: …………	Designation …………………
Date of receipt, Office Seal	Signature, Name/Designation of employee, receiving return"