FORM 12 OMITTED W.E.F. 01-04-2013

[See rule 24 (1)]

Exemption Certificate

Serial No.

Certified that _______(Name of the dealer)holding TIN ________under the Madhya Pradesh Vat Act, 2002 and carrying on the business known as________situated at ________town/village___________district__________of _____________________________ tehsil______Municipal ward No.__________(for municipal areas only) is not dealing in any goods taxable under the Madhya Pradesh Vat Act, 2002 and is not likely to deal in such goods, the said dealer is granted exemption from furnishing any returns in respect of the year commencing from ________ and ending on _______ .

RENEWALS

-------------------------------------------------