The Orissa Value Added Tax Rules, 2005 FORMS
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Body

FORM VAT-320A

APPLICATION FOR REFUND OF TAX

[see rule 65(1)(a), rule 65(2)(a), rule 65(3)(a), rule 66(1) and rule 66A(1)])

1	Office Address:	Date:
2	TIN:
3	Name of the Dealer:
4	Address of Dealer:
5	Refund for:................................. @ Export ............. @Input Tax Credit @ Sales under clasue (c) & (d) of section 18 @ Excess tax deducted at source
6	Tax Period:......................... From .................................... To ...................................................
7	Value of goods exported out of territory of India (for Export refund only):
8	Amount of
	input tax credit carried forward and due as refund :
	OR
	input tax due for refund as a result of export out of territory of India:
	OR
	Excess Tax Deducted at Source and due for refund
9	Amount of refund claimed:
10	Evidence to support claimed refund. (Documentary evidence if any to be produced at the time of audit / Assessment:
11	Bank details in which the refund claimed will be credited (if approved only)
	Bank Name:
	A/C Holder Name (to which the amount will be credited):
	A/C No:	IFSC Code:
	(The Bank details is mandatory otherwise the refund may not be approved)

12. Declaration:

I, Sri .................................................... status .............................................. of M/S ......................................... at ..................................... bearing TIN .................................. do hereby declare that the information given above are true and correct to the best of my knowledge and belief. I also further declare that the amount of refund claimed above has been paid by me and that the amount or any part thereof has not been realized by me by way of tax or otherwise from any person or persons.