FORM 38

[See rule 47(3)]

Application for refund of the unauthorized collected amount forfeited under section 35 of the Madhya Pradesh Vat Act, 2002

To,

The ...................... (designation),

..................................Circle.

I,..........................................................................................(Name of the person) ................................................ (address) hereby make an application for refund of a sum of Rs................................... unauthorized collected from me by........................................................................................(Name of the dealer) ................................................ (address) TIN.................................and forfeited by you under sub-section (3) of section 35 of the Madhya Pradesh Vat Act, 2002.

The amount of Rs...................... the refund of which is being claimed by me was collected from me by way of tax in respect of the goods................................(description of goods) purchased by me from the aforesaid seller and in support of my claim, I hereby enclose a copy of bill/cash memo No.............dated............... for Rs....................issued by the said dealer in respect of the purchase of the aforesaid goods.

ACKNOWLEDGMENT

Received an application in form 38 from shri ____________________________________

on date_____________

.............................................